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captopril Nursing Considerations & Management

Drug Name

Generic Name : captopril

Brand Name: Apo-Capto (CAN), Capoten, Gen-Captopril (CAN), Novo-Captopril (CAN), Nu-Capto (CAN)

Classification: ACE inhibitorAntihypertensive Pregnancy Category C (principal trimester) Pregnancy Category D (assist and third trimesters) 
Dosage & Route
  • PO HTN Initial: 12.5 mg twice daily. Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day. Heart insufficiency Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3 times/day. Post MI Start 3 days behind MI. Initial: 6.25 mg/day, may growth behind various wk to 150 mg/day in separated doses if needed and tolerated. Diabetic nephropathy 25 mg 3 times/day.
Therapeutic actions
  • Captopril competitively inhibits the alteration of angiotensin I (ATI) to angiotensin II (ATII), thus resulting in reprieved ATII levels and aldosterone secretion. It besides growths plasma renin essential-quality and bradykinin levels. Abatement of ATII leads to decreased sodium and instil remonstrance. By these mechanisms, captopril produces a hypotensive goods and a wholesome goods in congestive feeling insufficiency.
    • Absorption: 60-75% exhausted from the GI hope (oral); peak plasma concentrations behind 1 hr. Absorption may be reprieved in the influence of assistance.
    • Distribution: Protein-binding: 30%; crosses the placenta and enters obstruct milk at environing 1% of kind respect concentrations.
    • Excretion: Via urine (40-50% as unnatural, the pause as disulfide and other metabolites); 2-3 hr (encircleation half-life), may be growthd in renal feebleness. Removed by hemodialysis.
Indications
  • Treatment of hypertension over or in co-operation following a while thiazide-type diuretics
  • Treatment of CHF in unrepinings unresponsive to customary therapy; used following a while diuretics and digitalis
  • Treatment of diabetic nephropathy
  • Treatment of left ventricular dysadministration behind MI
  • Unlabeled uses: Management of hypertensive crises; matter of rheumatoid arthritis; singularity of anatomic renal artery stenosis, hypertension cognate to scleroderma renal crisis; singularity of chief aldosteronism, idiopathic edema; Bartter’s syndrome; Raynaud’s syndrome
Adverse goodss
  • Hypotension, tachycardia, chest affliction, palpitations, pruritus, hyperkalemia. Proteinuria; angioedema, skin rashes; nicety mobility, nonproductive cough, dissipation.
  • Potentially Fatal: Neutropenia, usually betides following a whilein 3 mth of starting therapy in-particular in unrepinings following a while renal dysadministration or collagen diseases. Hyperkalaemia. Anaphylactic reactions.
Contraindications
  • Known hypersensitivity to the garbage. Bilateral renal artery stenosis, ancestral angioedema; renal feebleness; pregnancy.
Nursing considerations
Assessment
  • History: Allergy to captopril, truth of angioedema, diminished renal administration, CHF, salt or book depletion, pregnancy, lactation
  • Physical: Skin hue, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal administration tests, CBC and differential
Interventions
  • Administer 1 hr antecedently meals.
  • WARNING: Ensure that unrepining is not delay-child antecedently threshold matter. Encourage use of contraceptives; if pregnancy is detected, bung garbage.
  • WARNING: Alert surgeon and token unrepining’s chart following a while heed that captopril is life graspn; the angiotensin II structure later to compensatory renin liberate during surgery get be blocked; hypotension may be reversed following a while book comment.
  • Monitor unrepining air-tight for faint in BP assistary to abatement in soft book (due to immoderate perspiration, and dehydration, vomiting, or diarrhea); immoderate hypotension may betide.
  • Reduce dosage in unrepinings following a while diminished renal administration.
Teaching points
  • Take garbage 1 hour antecedently meals; do not grasp following a while assistance. Do not bung following a whileout canvassing your sanity prevention provider.
  • Be preventionful of faint in respect influence (occurs most repeatedly following a while diarrhea, sweating, vomiting, or dehydration); if light-headedness or dizziness betides, canvass your sanity prevention provider.
  • Severe fetal waste can betide if captopril is graspn during pregnancy. Use of contraceptives is advised; if pregnancy should betide, bung garbage and apprise sanity prevention provider.
  • Avoid over-the-counter medications, in-particular cough, dispassioned, allergy medications that may hold ingredients that get interact following a while ACE inhibitors. Canvass your sanity prevention provider.
  • You may trial these edge goodss: Cough, GI overthrow, waste of craving, transmute in nicety apprehension (scant goodss, get by); opening shrewds (recurrent opening prevention may succor); rash; secure feeling rate; dizziness, light-headedness (usually byes behind the principal few days; transmute collocation sloth, and condition your activities to those that do not exact alertness and preciseness).
  • Report opening shrewds; shrewd throat, flush, chills; turgescence of the hands or feet; riotous feelingbeat, chest afflictions; turgescence of the aspect, eyes, lips or tongue; difficulty breathing.

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