Enace D-5mg

Enalapril Maleate/Hydrochlorothiazide Action Indications Contraindications Route/Dosage Interactions Lab Test Interferences Adverse Reactions Precautions Patient Care Considerations Administration/Storage Assessment/Interventions Patient/Family Education (EH-NAL-uh-prill MAL-ee-ate high-droe-klor-oh-THIGH-uh-zide) Vaseretic 10–25, Vaseretic Class: Antihypertensive Action Enalapril causes vasodilation and decreased blood pressure; hydrochlorothiazide causes loss of body water and increases urine output. Indications Treatment of hypertension. Contraindications Hypersensitivity to any component or to other sulfonamide-derived drugs; history of angioedema related to previous treatment with acetylcholinesterase (ACE) inhibitor; anuria. Route/Dosage ADULTS: PO 1 to 2 tablets (each containing 10 mg enalapril maleate and 25 mg hydrochlorothiazide) per day. Interactions Cholestyramine and colestipol resins: May bind to hydrochlorothiazide and decrease its bioavailability. Diazoxide: Hyperglycemia may occur. Digitalis glycosides: Arrhythmias may occur. Indomethacin: Hypotensive effects may be reduced. Lithium: Toxicity risk is greater; avoid use. Loop diuretics: Synergistic effects may cause profound diuresis and electrolyte abnormalities. Potassium preparations, potassium-sparing diuretics: May increase serum potassium levels. Sulfonylureas: May require dose adjustment. Lab Test Interferences PBI levels may be decreased without signs of thyroid disturbances; diagnostic interference with serum electrolyte levels, blood and urinary glucose levels, serum bilirubin levels and serum uric acid levels. Adverse Reactions CV: Hypotension; orthostatic effects; palpitations; tachycardia; chest pain. DERM: Rash, pruritus. CNS: Dizziness; headache; insomnia; nervousness; paresthesia; somnolence; vertigo; syncope. EENT: Tinnitus; dry mouth. GI: Nausea; diarrhea; abdominal pain; vomiting; dyspepsia; constipation; flatulence. GU: Impotence; decreased libido; urinary tract infections. HEMA: Neutropenia; agranulocytosis. META: Hyperkalemia; hyponatremia; hypercalcemia; hypochloremic alkalosis; hypokalemia; gout; hypomagnesemia; hyperglycemia; increased triglyceride and cholesterol levels. RESP: Chronic cough; dyspnea. OTHER: Angioedema; fatigue; weakness; muscle cramps; back pain; sweating. Precautions Pregnancy: Category D (second, third trimester); Category C (first trimester). Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Angioedema: Angioedema of face, extremities, lips, tongue, glottis or larynx has been reported in patients treated with enalapril. Discontinue drug. Bone marrow depression: Other ACE inhibitors have caused bone marrow depression, particularly in patients with renal impairment and collagen vascular disease. Monitor hematopoietic system. Diabetes: Monitor closely, because adjustments may be needed in hypoglycemic agents. Renal and hepatic impairment: Use drug with caution in patients with renal disease and monitor renal function periodically; may precipitate azotemia; may alter renal function in susceptible individuals (including those with severe CHF). Use drug with caution in patients with impaired hepatic function or progressive liver disease, because changes in fluid and electrolyte balance can precipitate hepatic coma. Systemic lupus erythematosus: May be activated or exacerbated. PATIENT CARE CONSIDERATIONS Administration/Storage If patient is receiving diuretics keep patient under medical supervision for 2 hr after initial dose. Continue to monitor patient until blood pressure is stable for 1 hr. Give with food or milk if nausea occurs. Store at room temperature in sealed container. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Obtain baseline vital signs. Review baseline creatinine, BUN, magnesium, glucose, triglyceride, cholesterol, serum electrolytes and liver function test results. After initial dose, monitor vital signs for 2 hr until vital signs are stable for 1 hr. Assist patient with postural changes, and monitor orthostatic BP frequently during initial therapy and regularly thereafter. In diabetic patients, monitor blood glucose closely. Monitor I&O, serum electrolytes, liver function test results, glucose and CBC. Assess for vertigo, somnolence, headache, nausea, abdominal pain. Notify physician if severe hypotension, chest pain or arrhythmia occur. OVERDOSAGE: SIGNS & SYMPTOMS Hypotension, orthostatic hypotension, dizziness, drowsiness, syncope, electrolyte abnormalities, hemoconcentration, confusion, muscular weakness, nausea, vomiting, depressed respiration, lethargy, coma Patient/Family Education Advise patient to take with food or milk if nausea occurs. Caution patient that medication increases urination and to take as early in day as possible. Advise patient that lethargy may be experienced until body adjusts. Caution patient to take missed dose as soon as possible but not to take missed dose with next dose. If more than one dose is missed, tell patient to contact physician. Advise patient not to use salt substitutes unless approved by physician. Instruct patient to report these symptoms to physician: weakness, muscle cramps, dizziness, nausea, neck or facial swelling, faintness on standing, sore throat or dry, persistent cough.