Captopril Nursing Responsibilities

 Brand Name: Capoten
Classification: Angiotensin Converting Enzyme (ACE) Inhibitor, Antihypertensive
Indications

• Hypertension
• Management of congestive heart failure (CHF)
• Reduces the risk of death or development of CHF after myocardial infarction (MI)
• Slows the progression of left ventricular dysfunction  into overt heart failure
• Used to decreased the progression of diabetic neuropathy

Mechanism of Action

• Captopril (Capoten) is an angiotension converting enzyme inhibitor. An Angiotensin-Converting Enzyme converts angiotensin I to angiotensin II. Angiotensin II is a potent endogenous vasoconstrictor substance.
• ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. It also inactivates the vasodilator bradykinin and other vasodilatory prostaglandins.
• ACE inhibitors also increase plasma rennin levels and reduce aldosterine levels. This is due to the suppression of the rennin-angiotensin-aldosterone system resulting in decreased serum concentrations of angiotensin I and aldosterone. The reduction of angiotensin I leads to decreased aldosterone secretion and as a result small increases in serum potassium may occur along with sodium and fluid loss.

Contraindications

1. Hypersensitivity
2. Cross sensitivity among Ace inhibitors
3. Pregnancy
4. Angioedema (hereditary or idiopathic)

Use cautiously in

1. Renal impairment
2. Hepatic impairment
3. Hypovolemia
4. Hyponatremia
5. Elderly patients
6. Concurrent diuretic therapy
7. Surgery or anesthesia
8. Lactation
9. Children

Side Effects

1. Dizziness or lightheadedness
2. Fatigue
3. Headache
4. Insomnia
5. Weakness or excessive tiredness
6. Cough
7. Hypotension
8. Tachycardia or fast heartbeat
9. Taste disturbances: salty or metallic taste or decreased ability to taste
10. Diarrhea
11. Nausea
12. Proteinuria
13. Hyperkalemia
14. Sore throat
15. Fever
16. Mouth sores
17. Unusual bruising

Nursing Management

1. Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. (for patients treated with hypertension)
2. For patients treated with CHF, monitor weight and assess patient routinely for resolution of fluid overload. Signs of fluid overload are: peripheral edema, rales or crackles, dyspnea, weight gain and jugular vein distention.
3. The nurse should keep in mind that Captopril may cause false-positive result for urine acetone.
4. The drug should be administered 1 hour before or 2 hours after meals. It may be crushed if the patient has difficulty swallowing.
5. Keep this medication in the container it came in, tightly closed, and out of reach of children.
6. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
7. Throw away any medication that is outdated or no longer needed.
8. Inform the patient that Captopril tablets may have a slight sulfur odor (like rotten eggs).
9. Instruct the patient to notify the physician immediately when the following manifestations are experienced:

• chest pain
• swelling of the face, eyes, lips, tongue, arms, or legs
• difficulty breathing or swallowing
• fainting
• rash