Question

Sophie Helms, an elderly patient, has just been given a new anti-hypertensive medication, enalapril 5 mg once daily. She also has Type II diabetes and takes metformin 500 mg one tablet twice a day along with one baby aspirin a day. She is calling in and asking how she should take her new medication and if it interacts with any of her other medications.

What factors might have an impact on the potential effect of the new medication? Are there interactions she should know about between her medications? What are the interactions and side effects she should watch for and what education should be given to the patient?

Answer 1

ENALAPRIL INTERACTIONS WITH METFORMIN

ENALAPRIL HAS ANTI HYPERGLYCEMIC EFFECT.IT INCREASES METFORMIN EFFECTS ON LOWERING BLOOD SUGAR.THIS COULD CAUSE HYPOGLYCEMIA.

ENALAPRIL WITH ASPIRIN

enalapril is used concamitantly with aspirin especially in patients with heart failure or ischemic heart disease.

affects prostaglandin mediated pathway which causes vasodilation.

enalapril reduces degradation of bradykinin and increases prostaglandin production

asoirin inhibits enzyme cyclo oxygenase and inhibits production of prostaglandin.

**ADVICES:

EDUCATE THE CLIENT REGARDING FOLLOWING ASPECTS

--AVOID ALCOHOL(IF USING)

--TO HAVE A GOOD BALANCED DIET BECAUSE ENALAPRIL HAS ANTI PROTINEURIC EFFECT

--TO HAVE PLENTY OF ORAL FLUIDS BECAUSE IT CAUSES INCREASED THIRST

--DONOT USE SALT SUBSTITUTE WITH OUT DOCTORS ADVICE

--AVOID EXCESS POTASSIUM SUPPLEMENTS BECAUSE ENALAPRIL CAUSES HYPERKALAEMIA.

--ADVICE PATIENT TO HAVE A CHECK ON HER BLOOD SUGAR LEVELS

--EDUCATE HER REGARDING SIDE EFFECTS OF ENALAPRIL--HYPOGLYCEMIA

HYPERKALAEMIA

HYPOTENSION

METABOLIC ACIDOSIS

INCREASED KIDNEY PROBLEMS

ANTI PROTEINURIC EFFECT

--EDUCATE ABOUT SYMPTOMS OF HYPOGLYCEMIA

*HEADACHE,HUNGER,WEAKNESS,NERVOUSNESS,DIZZINESS,DROWSINESS,SWEATINGS,CONFUSION,TREMORS,BLURRED VISION,RAPID HEART RATE,COLD AND CLAMMY

TELL HER IF SHE FACES ANY OF THE ABOVE SAID SYMPTOMS THEN SHE NEEDS TO VISIT A PRACTITIONER.

--EDUACATE REGARDING IMPORTANCE OF FOLLOW UP.