Drug Name - Nursing Crib
Drug Name |Dosage & Route |Action |Indication |Adverse Effects |Contraindication |Nursing Responsibility | |
CAPTOPRIL
(kap'toe-pril)
Capoten
Classifications: cardiovascular agent; angiotensin-converting enzyme (ace) inhibitor; antihypertensive agent
|
Hypertension
Adult: PO 6.25–25 mg t.i.d., may increase to 50 mg t.i.d. (max: 450 mg/d)
Child: PO 0.3–12.5 mg/kg q12–24h, may titrate up to max of 6 mg/kg/d in 2–4 divided doses
Infant: PO 0.15–0.3 mg/kg, may titrate up to 6 mg/kg/d in 1–4 divided doses
Neonate: PO 0.05–0.1 mg/kg q8–24 h, may titrate up to 0.5 mg/kg q6–24 h
Premature infant: PO 0.01 mg/kg q8–12h
Congestive Heart Failure
Adult: PO 6.25–12.5 mg t.i.d., may increase to 50 mg t.i.d. (max: 450 mg/d) |
Lowers blood pressure by specific inhibition of the angiotensin-converting enzyme (ACE). This interrupts conversion sequences initiated by renin that lead to formation of angiotensin II, a potent endogenous vasoconstrictor. ACE inhibition alters hemodynamics without compensatory reflex tachycardia or changes in cardiac output (except in patients with CHF). Peripheral vascular resistance is lowered by vasodilation. Inhibition of ACE also leads to decreased circulating aldosterone. Reduced circulating aldosterone is associated with a potassium-sparing effect. In heart failure, captopril administration is followed by a fall in CVP and pulmonary wedge pressure; hypotensive action appears to be unrelated to plasma renin levels. |
Hypertension; in conjunction with digitalis and diuretics in CHF, diabetic nephropathy. |
Body as a Whole: Hypersensitivity reactions, serum sickness-like reaction, arthralgia, skin eruptions. CV: Slight increase in heart rate, first dose hypotension, dizziness, fainting. GI: Altered taste sensation (loss of taste perception, persistent salt or metallic taste); weight loss, intestinal angioedema. Hematologic: Hyperkalemia, neutropenia, agranulocytosis (rare). Respiratory: cough. Skin: Maculopapular rash, urticaria, pruritus, angioedema, photosensitivity. Urogenital: Azotemia, impaired renal function, nephrotic syndrome, membranous glomerulonephritis. Other: Positive antinuclear antibody (ANA) titers. |
Angioedema, hypersensitivity to captopril or ACE inhibitors; hypotension; pregnancy (category D), lactation. |
Assessment & Drug Effects
• Monitor BP closely following the first dose. A sudden exaggerated hypotensive response may occur within 1–3 h of first dose, especially in those with high BP or on a diuretic and restricted salt intake.
• Advise bed rest and BP monitoring for the first 3 h after the initial dose.
• Monitor therapeutic effectiveness. At least 2 wk of therapy may be required before full therapeutic effects are achieved.
• Lab tests: Establish baseline urinary protein levels before initiation of therapy and check at monthly intervals for the first 8 mo of treatment and then periodically thereafter. Perform WBC and differential counts before therapy is begun and at approximately 2-wk intervals for the first 3 mo of therapy and then periodically thereafter.
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