Inter American University of Puerto Rico
Correspondence to this article should be addressed to Alma Flores, Carmen Torres de Tiburcio Department of Nursing, Inter American University of Puerto Rico, Metropolitan Campus, Road 1 Km 16.3 Corner, Francisco Sein Street, Rio Piedras, PR 00919. E-mail: email@example.com
ACEinhibitors (angiotensin-converting-enzyme inhibitors) are now considered first-choice treatment and are the cornerstone of heart failure drug therapy. In studies involving thousands of patients, ACE inhibitors have been proven to slow the progression of heart failure. They are a type of vasodilator, which are medications that cause the blood vessels to expand, lowering blood pressure and reducingthe heart's workload. ACE inhibitors prevent the body from creating angiotensin, a substance in the blood that causes vessels to tighten and raises blood pressure.
The following drugs belong to the Ace inhibitors category: enalapril (Vasotec), captopril (Capoten), ramipril (Altace) among others. Just the ones mentioned before are going to be presented in detail.
In order to pumpblood, the heart needs oxygen. The harder the heart works, the more oxygen it requires. Angina (heart pain) occurs when the supply of oxygen to the heart is inadequate for the amount of work the heart must do. By dilating the arteries, calcium channel blockers (CCBs) reduce the pressure in the arteries. This makes it easier for the heart to pump blood, and, as a result, the heart needs less oxygen. Byreducing the heart's need for oxygen, CCBs relieve or prevent angina. CCBs also are used for treating high blood pressure because of their blood pressure-lowering effects. CCBs also slow the rate at which the heart beats and are therefore used for treating certain types of abnormally rapid heart rhythms. The drug adenosine (Adenocard, Adenoscan) would be presented in detail.Potassium-channel blockers comprise the Class III antiarrhythmic compounds according to the Vaughan-Williams classification scheme. These drugs bind to and block the potassium channels that are responsible for phase 3 repolarization. Therefore, blocking these channels slows (delays) repolarization, which leads to an increase in action potential duration and an increase in the effective refractory period(ERP). By increasing the ERP, these drugs are very useful in suppressing tachyarrhythmias caused by reentry mechanisms. The drug amiodarone (Cordarone) belong to this class and it will be presented in detail.
Drug: enalapril (Vasotec) ACE inhibitor
Dosage and Route: PO; 5-40mg in a single dose or 2 divided doses (max: 40mg/day)
Action of Medication
This drug belongs to a group of medicationscalled ACE inhibitors. It is used to treat high blood pressure (hypertension) in adults and children. It works by relaxing blood vessels, causing them to widen. Lowering high blood pressure helps prevent strokes, heart attacks and kidney problems. This medication is also used with other drugs (e.g., "water pills"/diuretics, digoxin) to treat congestive heart failure.
Prior toadministration-Obtain a complete health history including recent cardiac events and any incidence of angioedema (leads to laryngeal swelling which can cause asphyxia/symptoms: severe paroxysm of dry coughing and stridor), allergies, drug history, and possible drug interactions. Obtain baseline ECG and vital signs (assess BP-possible hypotension). Assess neurological status and levels ofconsciousness (can cause decreased circulation to the brain owing to vasodilation). Obtain blood and urine specimens for laboratory analysis (medication can decrease WBC count thus decreasing the ability to fight infections/Monitor liver and kidney function-may cause hyperkalemia). Labs: May increase values of the following: BUN, alkaline phosphate, serum potassium, serum creatine, ALT, and AST; may...