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Name /bks_53161_deglins_md_disk/captopril
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TIME/ACTION PROFILE (effect on BP— single dose†)
1
captopril (kap-toe-pril)
Capoten
Classification
Therapeutic: antihypertensives
Pharmacologic: ACE inhibitors
Pregnancy Category D
ONSET
PEAK
DURATION
PO
15–60 min
60–90 min
6–12 hr
†Full effects may not be noted for several weeks
Contraindications/Precautions
Contraindicated in: Hypersensitivity; History of angioedema with previous use of
Indications
Alone or with other agents in the management of hypertension. Management of heart
failure. Reduction of risk of death, heart failure-related hospitalizations, and development of overt heart failure following myocardial infarction. Treatment of diabetic
nephropathy in patients with Type 1 diabetes mellitus and retinopathy.
Action
Angiotensin-converting enzyme (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 alsoqplasma renin
levels andpaldosterone levels. Net result is systemic vasodilation. Therapeutic
Effects: Lowering of BP in patients with hypertension. Improved survival and reduced symptoms in patients with heart failure. Improved survival and reduced development of overt heart failure after myocardial infarction. Decreased progression of
diabetic nephropathy with decreased need for transplantation or dialysis.
Pharmacokinetics
Absorption: 60– 75% absorbed following oral administration (decreased by
food).
Distribution: Crosses the placenta; enters breast milk in small amounts.
Metabolism and Excretion: 50% metabolized by the liver to inactive compounds, 50% excreted unchanged in urine.
Half-life: Infants with HF: 3.3 hr (range 1.2– 12.4 hr); Children: 1.5 hr (range
0.98– 2.3 hr); Adults: 1.9 hr (qto 20– 40 hr in renal impairment); Adults with HF:
2.1 hr.
⫽ Canadian drug name.
ROUTE
⫽ Genetic Implication.
ACE inhibitors; Concurrent use with aliskiren in patients with diabetes or moderateto-severe renal impairment (CCr ⬍60 mL/min); OB: Can cause injury or death of fetus – if pregnancy occurs, discontinue immediately; Lactation: Discontinue drug
or use formula.
Use Cautiously in: Patients with collagen vascular disease, renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy; Surgery/anesthesia (hypotension may be exaggerated); Black patients (monotherapy for hypertension
less effective, may require additional therapy; higher risk of angioedema); Women of
childbearing potential; Geri: Initial doseprecommended.
Exercise Extreme Caution in: History of angioedema.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache, insomnia. Resp: cough. CV: hypotension, chest
pain, palpitations, tachycardia. GI: taste disturbances, abdominal pain, anorexia,
constipation, diarrhea, nausea, vomiting. GU: proteinuria, impaired renal function.
Derm: ANGIOEDEMA, rash, pruritis. F and E: hyperkalemia. Hemat: AGRANULOCYTOSIS, neutropenia. Misc: fever.
Interactions
Drug-Drug: Excessive hypotension may occur with concurrent use of diuretics.
Additive hypotension with other antihypertensives.qrisk of hyperkalemia with
concurrent use ofpotassium supplements, potassium-sparing diuretics, or
potassium-containing salt substitutes.qrisk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor antagonists or aliskiren; avoid concurrent use with aliskiren in patients with diabetes
or CCr ⬍60 mL/min. NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect andqthe risk of renal dysfunction.qlevels and mayqthe risk of
lithium toxicity.
Drug-Natural Products: Avoid natural licorice (causes sodium and water retention and increases potassium loss).
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Drug-Food: Food significantly pabsorption. Administer captopril 1 hr before
Plate # 0-Composite
● Monitor frequency of prescription refills to determine compliance.
● Assess patient for signs of angioedema (dyspnea, facial swelling).
● Heart Failure: Monitor weight and assess patient routinely for resolution of fluid
meals.
Route/Dosage
Note: Use lower doses (1/2 of those listed) in patients who are sodium and water depleted due to diuretics.
Hypertension
PO (Adults and Adolescents): 12.5– 25 mg 2– 3 times daily, may beqat 1– 2 wk
intervals up to 150 mg 3 times daily (initiate therapy with 6.25– 12.5 mg 2– 3 times
daily in patients receiving diuretics).
Heart Failure
PO (Adults): 25 mg 3 times daily (6.25– 12.5 mg 3 times daily in patients who have
been vigorously diuresed); titrated up to target dose of 50 mg 3 times daily (max dose
⫽ 450 mg/day).
PO (Children): 0.3 mg/kg— 0.5 mg/kg/dose 3 times daily, titrate up to a maximum
of 6 mg/kg/day in 2– 4 divided doses; Older Children: 6.25– 12.5 mg/dose q 12– 24
hr, titrate up to a maximum of 6 mg/kg/day in 2– 4 divided doses.
PO (Infants): 0.15– 0.3 mg/kg/dose, titrate up to a maximum of 6 mg/kg/day in 1–
4 divided doses.
PO (Neonates): 0.05– 0.1 mg/kg/dose q 8– 24 hr, mayqas needed up to 0.5 mg/
kg q 6– 24 hr; Premature neonates: 0.01 mg/kg/dose q 8– 12 hr.
Left Ventricular Dysfunction Post-MI
PO (Adults): 6.25-mg test dose, followed by 12.5 mg 3 times daily, may bequp to
50 mg 3 times daily.
Diabetic Nephropathy
PO (Adults): 25 mg 3 times daily.
Renal Impairment
PO (Adults): ClCr 10– 50 mL/min: Administer 75% of dose; ClCr ⬍10 mL/min: Administer 50% of dose.
NURSING IMPLICATIONS
Assessment
● Hypertension: Monitor BP and pulse frequently during initial dose adjustment
and periodically during therapy. Notify health care professional of significant
changes.
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overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous
distention).
Lab Test Considerations: Monitor renal function. May causeqBUN and serum creatinine. IfqBUN or serum creatinine concentrations occur, may require
dose reduction or withdrawal.
May cause hyperkalemia.
May causeqAST, ALT, alkaline phosphatase, and serum bilirubin.
Assess urine protein prior to and periodically during therapy for up to 1 yr in patients with renal impairment or those receiving ⬎ 150 mg/day of captopril. If excessive or increasing proteinuria occurs, re-evaluate ACE inhibitor therapy.
May cause positive antinuclear antibody (ANA) titer.
Monitor CBC with differential prior to initiation of therapy, every 2 wk
for the first 3 mo, and periodically for up to 1 yr in patients at risk for
neutropenia (patients with renal impairment, or collagen-vascular disease) or at first sign of infection. Discontinue therapy if neutrophil count
is ⬍1000/mm3.
May cause false-positive test results for urine acetone.
Potential Nursing Diagnoses
Decreased cardiac output (Indications) (Side Effects)
Noncompliance (Patient/Family Teaching)
Implementation
● Do not confuse captopril with carvedilol.
● Correct volume depletion, if possible, before initiation of therapy due to possible
precipitous drop in BP during first 1– 3 hr following first dose. Risk of hypotension may be decreased by discontinuing diuretics or cautiously increasing salt intake 2– 3 days prior to beginning captopril. Monitor BP closely. Resume diuretics
if BP is not controlled.
● PO: Administer 1 hr before meals or 2 hr after meals. May be crushed if patient
has difficulty swallowing. Tablets may have a sulfurous odor.
● An oral solution may be prepared by crushing the tablets.
Patient/Family Teaching
● Instruct patient to take captopril as directed at the same time each day, even if feel-
ing well. Take missed doses as soon as remembered but not if almost time for next
䉷 2015 F.A. Davis Company
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check BP at least weekly and to report significant changes to health care professional.
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● Instruct patient and family on correct technique for monitoring BP. Advise them to
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Evaluation/Desired Outcomes
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 containing potassium or foods containing
high levels of potassium or sodium unless directed by health care professional.
Caution patient to change positions slowly to minimize orthostatic hypotension.
Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic 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 impairment 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 occurs; 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 immediately if pregnancy is planned or suspected.
Emphasize the importance of follow-up examinations to evaluate effectiveness of
medication.
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.
⫽ Canadian drug name.
⫽ Genetic Implication.
● Decrease in BP without appearance of excessive side effects.
● Improvement in survival and reduction of symptoms in heart failure.
● Reduction of risk of death or development of heart failure following myocardial
infarction.
● Decrease in progression of diabetic nephropathy.
Why was this drug prescribed for your patient?
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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