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(EH-NAL-uh-prill-at)
Vasotec IV
Class: Antihypertensive/ACE inhibitor

 Action Competitively inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Clinical consequences include decrease in sodium and fluid retention, decrease in blood pressure and increase in diuresis.

 Indications Treatment of hypertension when oral therapy is not practical. Unlabeled use(s): Hypertensive emergencies.

 Contraindications Standard considerations.

 Route/Dosage

IN ADULT PATIENTS NOT TAKING DIURETICS: IV 1.25 mg over 5 min q 6 hr. IN ADULT PATIENTS TAKING DIURETICS: IV 0.625 mg over 5 min. If inadequate response after 1 hr, may repeat 0.625 mg. Give additional doses of 1.25 mg q 6 hr.

 Interactions

Allopurinol: Greater risk of hypersensitivity possible with coadministration. Antacids: Enalaprilat bio-availability may be decreased. Separate administration times by 1 to 2 hr. Capsaicin: Cough may be exacerbated. Digoxin: Increased digoxin levels. Indomethacin: Hypotensive effects may be reduced, especially in low-renin or volume-dependent hypertensive patients. Lithium: Increased lithium levels and symptoms of lithium toxicity may occur. Phenothiazines: May increase pharmacological effect of phenothiazines. Potassium preparations, potassium-sparing diuretics: May increase serum potassium levels. Rifampin: Pharmacologic effects of enalapril may be decreased.

 Lab Test Interferences False elevation of liver enzymes, serum bilirubin, uric acid or blood glucose may occur.

 Adverse Reactions

CV: Chest pain; myocardial infarction; hypotension; angina; orthostatic hypotension; tachycardia. CNS: Headache; vertigo; dizziness; fatigue; asthenia; syncope. DERM: Rash; photosensitivity. GI: Nausea; abdominal pain; vomiting; diarrhea. GU: Urinary tract infection. HEMA: Decreased hemoglobin and hematocrit; neutropenia; agranulocytosis; thrombocytopenia; pancytopenia; eosinophilia. META: Hyperkalemia. RESP: Bronchitis; cough; dyspnea. OTHER: Fever; myalgia; arthralgia; arthritis; vasculitis.

 Precautions

Pregnancy: Category D (second, third trimester); Category C (first trimester). Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Angioedema: May occur. Use extreme caution in patients with hereditary angioedema. Cough: Chronic severe cough may occur during treatment. Hypotension/first-dose effect: Significant decreases in blood pressure may occur following first dose, especially in severely salt- or volume-depleted patients or those with heart failure; monitor closely for at least 2 hr after initial dose and during first 2 wk of therapy. Minimize risk by discontinuing diuretics, decreasing dose or increasing salt intake approximately 1 wk prior to initiating enalaprilat. Neutropenia and agranulocytosis: Have occurred; risk appears greater with renal dysfunction, heart failure or immunosuppression; monitor WBC counts periodically. Proteinuria: May occur, especially in patients with prior renal disease or those receiving high doses. Renal impairment: Reduce dose and give less frequently. In renal insufficiency, stable elevations in BUN and serum creatinine may occur due to inadequate renal perfusion; monitor renal function during first few weeks of therapy and adjust dosage.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Dilute with 0.9% normal saline in D5W or 5% Dextrose in Lactated Ringer’s.
  • Give as slow IV infusion over 5 min.
  • Store at room temperature and discard after 24 hr.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Obtain baseline vital signs, LFT results, serum bilirubin, uric acid, electrolytes, CBC, creatinine and BUN, and monitor these values throughout therapy.
  • Monitor vital signs closely after initial dose, at least 2 hr and during first 2 wk of therapy. Peak effect with initial dose may be 4 hr after injection.
  • Notify physician of any adverse reaction, including angioedema, chest pain, hypotension, tachycardia, dyspnea, bronchitis, vertigo, nausea or vomiting.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension

 Patient/Family Education

  • Advise patient to notify nurse of any vertigo, chest pain, techycardia, dyspnea, persistent cough, nausea or vomiting.
  • Caution patient not to discontinue drug suddenly.

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