After reviewing M.G.'s medications, the physician writes the ...

[notis]

After reviewing M.G.'s medications, the physician writes the following medication orders.
 
  Medication Orders
  Enalapril (Vasotec) 5 mg PO bid
  Carvedilol (Coreg) 3.125 mg PO twice daily
  Glipizide (Glucotrol) 10 mg PO every morning
  Furosemide (Lasix) 80 mg intravenous push (IVP) now, then 40 mg/day IVP
  Potassium chloride (K-Dur) 20 mEq/day PO
 
  What is the rationale for changing the route of the furosemide (Lasix)?

Question 2

How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce HF? Select all that apply. ACE inhibitors:
 
  a. prevent the conversion of angiotensin I to angiotensin II.
  b. cause systemic vasodilation.
  c. promote the excretion of sodium and water in the renal tubules.
  d. reduce preload and afterload.
  e. increase cardiac contractility.
  f. block sympathetic nervous system stimulation to the heart.

[poopface]

Answer to Question 1

M.G. is fluid overloaded and needs to decrease fluid volume in a short period. Intravenous
administration is delivered directly into the vascular system, where it can start to work immediately.
In HF, blood flow to the entire gastrointestinal (GI) system is compromised; therefore the absorption
of orally ingested medications may be variable and take longer to work.

Answer to Question 2

Answers: a, b, d
ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.
This results in systemic vasodilation, thereby reducing preload (reducing the volume of blood
entering the left ventricle) and afterload (reducing the resistance to the left ventricular contraction)
in patients with HF. ACE inhibitors do not promote the excretion of sodium and water, and they do
not cause increased cardiac contractility or block the sympathetic nervous system to the heart.

[notis]

Excellent

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Gracias!