The nurse is educating a client on the possible side effects associated with quinapril. Which of the following side effects are associated with this medication classification?(Select All that Apply)
angioedema
dry non-productive cough
hyperkalemia
first dose phenomenon
hypotension
Hypertension
Correct Answer : A,B,C,D,E
A) Angioedema: Quinapril, an ACE inhibitor, can cause angioedema, which is a serious allergic reaction characterized by swelling of the deeper layers of the skin. This side effect is critical to monitor, as it can lead to airway obstruction.
B) Dry non-productive cough: A persistent dry cough is a well-known side effect of ACE inhibitors like quinapril. This occurs due to the accumulation of bradykinin and can be bothersome enough to require discontinuation of the medication.
C) Hyperkalemia: Quinapril can lead to increased potassium levels in the blood, a condition known as hyperkalemia. This is due to the drug's mechanism of action, which reduces aldosterone secretion, leading to decreased potassium excretion.
D) First dose phenomenon: This refers to a significant drop in blood pressure following the first dose of an ACE inhibitor, which can lead to dizziness or fainting. Patients are often advised to take the first dose at bedtime to minimize this risk.
E) Hypotension: Quinapril can cause hypotension, particularly after the initial dosing or in patients who are dehydrated or on diuretics. It’s important for patients to be aware of this potential side effect.
F) Hypertension: Quinapril is used to treat hypertension, so it is not a side effect associated with this medication. Instead, the goal of treatment is to lower blood pressure, making this option incorrect.
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Correct Answer is D
Explanation
A) Pancytopenia: While some medications can cause pancytopenia, it is not a common or direct side effect of alteplase. This condition involves a reduction in red blood cells, white blood cells, and platelets, and is not typically associated with thrombolytics.
B) Hypertension: Alteplase is not known to cause hypertension. In fact, the goal of administering alteplase in the context of a pulmonary embolism is to dissolve the clot and restore normal blood flow, which may help stabilize blood pressure.
C) Hypokalemia: This condition, characterized by low potassium levels, is not a common side effect of alteplase. There are other medications that may cause electrolyte imbalances, but alteplase itself is not typically linked to hypokalemia.
D) Internal bleeding: This is a significant risk associated with alteplase, as it is a thrombolytic agent that dissolves clots. The nurse should closely monitor for signs of internal bleeding, such as changes in vital signs, unexplained bruising, or blood in urine or stool. This is the most critical side effect to assess for in a client receiving alteplase
Correct Answer is A
Explanation
A) Losartan (Cozaar): This medication is an angiotensin II receptor blocker (ARB) and is often used as an alternative for patients who experience a cough due to ACE inhibitors. Unlike ACE inhibitors, ARBs do not typically cause a cough because they do not affect bradykinin levels, making losartan an appropriate choice for managing hypertension without the adverse effect of a persistent cough.
B) Hydralazine HCL (Apresoline): While hydralazine is an antihypertensive, it works through a different mechanism (direct vasodilation) and is not a first-line alternative for patients with a history of ACE inhibitor-induced cough. It's generally used in specific situations, such as severe hypertension or heart failure.
C) Furosemide (Lasix): This is a loop diuretic primarily used for conditions like heart failure or edema, rather than for the management of hypertension alone. It does not address the underlying hypertension in the same manner as ACE inhibitors or ARBs.
D) Metoprolol (Lopressor): This is a beta-blocker that can be used for hypertension, but it does not directly address the issue of cough related to ACE inhibitors. Switching to a beta-blocker may not be the best option if the client is specifically seeking to avoid the cough associated with ACE inhibitors.