Lotensin

Action

ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and decrease aldosterone levels. Net result is systemic vasodilation. *Therapeutic* *Effects*: Lowering of BP in hypertensive patients.

Metabolism/Excretion

Benazepril—Converted by the liver to benazeprilat, the active metabolite. 20% excreted by kidneys; 11-12% nonrenal (biliary elimination).

Adverse Effects

agranulocytosis, angiodema

Class/Indication

antihypertensives

Generic Name

benazepril

Side Effects

dizziness, drowsiness, fatigue, headache, insomnia, vertigo, weakness. *cough*, dyspnea. CV: *hypotension*, chest pain, edema, tachycardia. hyperuricemia *taste disturbances*, abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting. GU: erectile dysfunction, proteinuria, renal dysfunction, renal failure. flushing, pruritis, rashes. hyperkalemia. back pain, muscle cramps, myalgia. fever.

Nursing Implications

● Hypertension: Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes. ● Monitor frequency of prescription refills to determine adherence. ● Assess patient for signs of angioedema (dyspnea, facial swelling). ● HF: Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention). ● Lab Test Considerations: Monitor BUN, creatinine, and electrolyte levels periodically. Serum potassium, BUN and creatinine may be increased , whereas sodium levels may be decreased . If increased BUN or serum creatinine concentrations occur, dose reduction or withdrawal may be required. ● Monitor CBC periodically during therapy. Certain drugs may rarely cause slight decrease in hemoglobin and hematocrit, leukopenia, and eosinophilia. ● May cause increased AST, ALT, alkaline phosphatase, serum bilirubin, uric acid, and glucose. ● Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as possible but not if almost time for next dose. Do not double doses. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional. ● Caution patient to avoid salt substitutes or foods containing high levels of potassium or sodium unless directed by health care professional (see Appendix M). ● Caution patient to change positions slowly to minimize hypotension. Use of alcohol, standing for long periods, exercising, and hot weather mayqorthostatic hypotension.Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially cough, cold, or allergy remedies. ● May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known. ● Advise patient to inform health care professional of medication regimen prior to treatment or surgery. ● Advise patient that medication may cause impair- A ment of taste that generally resolves within 8-12 wk, even with continued therapy. ● Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occur; or if taste impairment or skin rash persists. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues. ● Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected. If pregnancy is detected, discontinue medication as soon as possible. ● Emphasize the importance of follow-up examinations to monitor progress. ● Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension. ● Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.