Medication Card – Enalapril (Vasotec®) (Kor/Eng)

Classification (분류)

• Therapeutic (치료적 분류): Antihypertensive (항고혈압제)
• Pharmacologic (약리학적 분류): ACE inhibitor (안지오텐신 전환효소 억제제)

 

Indications (적응증)

• Hypertension (고혈압)
• Heart failure (심부전)
• Asymptomatic left ventricular dysfunction (무증상 좌심실 기능부전)
• Prevention of progression after myocardial infarction (심근경색 후 심부전 진행 예방)

 

 

 

 

Therapeutic Effects (치료 효과)

• Lowers blood pressure (혈압 감소)
• Decreases afterload and preload (후부하, 전부하 감소)
• Improves symptoms of heart failure (심부전 증상 완화)
• Prevents progression of left ventricular dysfunction (좌심실 기능부전 진행 억제)

 

 

 

 

 

 

Absorption (흡수)

• Oral: ~60% absorbed; food has minimal effect (경구: 약 60% 흡수, 음식 영향 적음)

 

 

 

 

Distribution (분포)

• Widely distributed; crosses placenta & small amounts in breast milk (광범위 분포, 태반 통과, 모유에 소량 분비)

 

 

 

 

 

Protein Binding (단백결합)

• ~50–60% bound (약 50–60% 단백결합)

 

 

 

 

 

Metabolism & Excretion (대사 및 배설)

• Prodrug → metabolized in liver to enalaprilat (active form) (간에서 활성형 enalaprilat으로 전환)
• Excreted primarily by kidneys (주로 신장 배설)

 

 

 

 

 

 

Onset/Peak/Duration (작용발현/최고효과/지속시간)

• PO: Onset 1 hr / Peak 4–6 hr / Duration ≥24 hr (경구: 1시간 / 최고 4–6시간 / 24시간 이상 지속)

 

 

 

 

Adverse Effects (부작용, ADEs)

• CV (심혈관): Hypotension, dizziness, syncope (저혈압, 어지러움, 실신)
• Respiratory (호흡기): Persistent dry cough (지속적 마른 기침)
• Renal (신장): Elevated creatinine, hyperkalemia (크레아티닌 상승, 고칼륨혈증)
• Other: Angioedema (swelling of lips, tongue, throat → emergency) (혈관부종: 입술·혀·인후부 부종 → 응급상황)

 

 

 

 

 

Drug Interactions (약물 상호작용)

• ↑ Hyperkalemia risk: Potassium supplements, potassium-sparing diuretics (K 보충제, K 보존 이뇨제 → 고칼륨혈증 위험)
• ↑ Hypotension risk: Diuretics, other antihypertensives, alcohol (이뇨제, 다른 항고혈압제, 알코올 → 저혈압 위험)
• NSAIDs: May ↓ antihypertensive effect (NSAIDs → 항고혈압 효과 감소)
• Lithium: ↑ risk of lithium toxicity (리튬 독성 위험 증가)

 

 

 

 

Dose (용량)

• Hypertension (성인): 2.5–5 mg once daily, titrated to 10–40 mg/day (고혈압: 초기 2.5–5 mg/일 → 유지 10–40 mg/일)
• Heart failure: Start 2.5 mg BID, titrate up to 20 mg BID (심부전: 초기 2.5 mg 하루 2회 → 최대 20 mg 하루 2회)

(Dose adjusted for renal impairment; 노인/신장애 환자에서 용량 감소 필요)

 

 

 

 

 

 

Nursing Interventions (간호중재)

• Monitor blood pressure, heart rate regularly (혈압·심박수 주기적 확인)
• Monitor renal function & electrolytes (BUN, creatinine, potassium) (신기능·전해질 검사)
• Assess for cough, angioedema, dizziness (기침, 혈관부종, 어지러움 확인)
• Hold medication if systolic BP < 100 mmHg (수축기혈압 100mmHg 미만 시 투여 보류)

 

 

 

 

 

Patient Teaching (환자 교육)

• Take at the same time each day (매일 같은 시간에 복용)
• Report persistent dry cough or swelling of face/lips/tongue immediately (지속적 기침, 얼굴·입술·혀 붓기 시 즉시 보고)
• Avoid salt substitutes/high potassium foods (소금 대체제·고칼륨 음식 피하기)
• Rise slowly to prevent dizziness (체위성 저혈압 예방 위해 천천히 일어나기)
• Do not stop medication suddenly (약물 갑자기 중단 금지)

 

 

 

Enalapril,enalaprilat  (Epaned, Vasotec®,Vasotec IV )

ACE inhibitor/Antihypertensive

● Indications: Hypertension, HF,  Slowed progression left ventricular dysfunction into overt heart failure,

● Therapeutic effects: lowering of BP, improved symptoms in patients w/ HF, lower risk of MI, stroke or death from CVD causes in high-risk patients 

● Absorption:  Enalapril: 55–75% absorbed after PO, Enalaprilat: IV results in complete bioavailability

● Distribution:  cross the placenta, enter breast milk 

● Protein binding: 

● Metabolism&Excretion: converted by liver to enalaprilat, active metabolite, primarily eliminated by the kidneys

● ADE: CV; hypotension GI; taste disturbances Hemat; AGRANULOCYTOSIS Resp; cough Misc; ANGIOEDEMA, fever

● Dose: PO; HTN-2.5-5 mg/day upto 40mg/day in 1-2 divided doses, HF-2.5 mg 1–2 times/day up to 10mg/BID(begin 2.5mg/day with hyponatremia), Asymptomatic left ventricular dysfunction-2.5 mg/BID up to 10mg BID  IV; HTN-0.625-1.25mg Q6H (upto 5mg every 6hr), IV Push: Dilution: May be administered undiluted. Concentration: 1.25 mg/mL. Rate: Administer over at least 5 min. (IV 주사: 희석: 희석하지 않고 투여할 수 있습니다. 농도: 1.25 mg/mL. 속도: 최소 5분 이상에 걸쳐 투여하십시오.)

● Onset/Peak/Duration:  PO: Onset 1 hr, Peak 4–8 hr, Duration 12–24 hr, IV: Onset 15 min, Peak 1–4 hr,  Duration 2–4 hrs

● considerations:Assess of angioedema signs (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing); may occur at any time during therapy. Discontinue medication and provide supportive care.