Question

1. Mr. Tinsley is a 55-year-old lawyer who has been diagnosed with primary hypertension. The health care provider has informed the patient that lifestyle modifications must be made. He is prescribed captopril (Capoten) 25 mg PO b.i.d and hydrochlorothiazide.

a. The nurse is providing drug information to Mr. Tinsley when he asks the therapeutic action of ACE inhibitors.
b. What lifestyle modifications should the nurse instruct Mr. Tinsley to make?
c. What adverse effects should the nurse monitor in this patient?

Answer 1

Answer a) Drug information: Therapeutic action of ACE inhibitors

ACE inhibitors inhibit activity of ACE ( angiotensin converting enzyme) which causes conversion of angiotensin I into angiotensin II .

Angiotensin II is dangerous for hypertensive patients because:

• it is responsible for vasoconstriction (narrowing of blood vessels leads to further increase in BP)
• Water retention
• sodium and chloride ion tubular reabsorption from kidneys

All these causes increase in blood volume that leads to further increase in BP.

So, in case of hypertension we need to decrease angiotensin II production so we will inhibit the enzyme responsible for making angiotensin II by using ACE inhibitors (like captopril) which causes widening ( vasodilation) of blood vessels and decreases water retention thereby decreases fluid volume that helps in reducing blood pressure.

b) lifestyle modifications :

1. Physical activity: physiotherapy and daily exercise ( moderate intensity like jogging , walking) and avoid sedentary lifestyle.

2. Changes in diet: eat plenty of fresh fruits and vegetables, reduce intake of NaCl (salt)

3. Avoid / reduce alcohol consumption  

4. Quit smoking

5. Weight control  

C) adverse effects: dizziness, lightheadedness, loss of taste, dry cough, skin rash

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