Ramipril Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Ramipril

Brand Name: Altace

Pregnancy Category C (first trimester), Pregnancy Category D (second and third trimesters)

Drug classes: Antihypertensive, Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic actions

Ramipril blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.

Indications

· Treatment of hypertension alone or in combination with thiazide-type diuretics

· Treatment of CHF in stable patients in the first few days after MI

· To decrease the risk of cardiovascular disease in patients at risk for developing CAD

Contraindications

· Contraindicated with allergy to ramipril, pregnancy (embryocidal in preclinical studies).

Adverse effects

Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in salt/volume depleted patients

Rash, pruritus, pemphigoid-like reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity, alopecia

Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation

Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency

Neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia, pancytopenia

Cough, malaise, dry mouth, lymphadenopathy, angioedema

Drug Interactions:

· Exacerbation of cough if taken with capsaicin

· Increased serum levels and increased toxicity with lithium; monitor patient closely

Nursing considerations

· Administer 1 hr before or 2 hr after meals.

· Discontinue diuretic for 2–3 days before beginning therapy, if possible, to avoid severe hypotensive effect.

· Open capsules and sprinkle contents over a small amount of applesauce or mix in applesauce or water if patient has difficulty swallowing capsules. Mixture is stable for 24 hr at room temperature and 48 hr if refrigerated.

· Alert surgeon and mark chart that ramipril is being used; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion.

· Monitor patient closely for falling BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.

· Reduce dosage in patients with impaired renal function.