Research Paper on Lisinopril

Introduction

Lisinopril is classified under angiosperm enzyme inhibitors also known as ACE inhibitors. The drugs are in the form of tablets and are administered orally. The recommended standard dosage for adults entails three parts: the initial dosage, maintenance dosage and lastly the maximum dosage in a day. The initial dosage is 10 mg, taken by mouth once daily while the usual or maintenance dosage is 20-40mg taken once per day, and lastly, the maximum dosage taken should be 80 mg per day. The drugs function in the body through the widening of the blood vessels, therefore, allowing flossing of blood smoothly hence efficient functioning of the heart (Lisinopril, 2018).

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Information for Discussion With the Patient

The patient should adhere to the medications as prescribed by the doctor. Also, the patient should carefully refer to the directions provided in the prescription label; however, the doctor may change the dosage depending on the evaluation to achieve the best results. Moreover, water is crucial while under medication thus, the patient ought to drink plenty of water.

Adverse Reactions

Lisinopril, just like most drugs, has unwanted effects that are universally common and uncommon side effects. The most common side effects include; sweating, blurred vision, cloudy urine, dizziness and the output of urine concentration decreases and finally, a patient will fell unusual tiredness. The less common side effects that a patient is likely to experience are stomach pain, difficulty in breathing, fever. Common cold, vomiting, nausea and congestion of the ear. Dietary restrictions

The patient should avoid alcohol entirely as it lowers the blood pressure, consequently increasing the side effects of Lisinopril. The drug also leads to decreased sweating; therefore, the patient should avoid dehydration especially during exercise (Jones & Bartlett Learning, 2018).

Furosemide

Furosemide is classified as loop diuretic water pills that prevent the body to take in too much salt in its place passed to the urine for excretion hence decreasing salt reabsorption by the kidneys. The drug is administered as tablets or through IV form or oral solution. The recommended dosage for adult tablets is 20mg to 80 mg per day based on the medical condition of the patient: Oral solution 8- 10mg/ml and injection; 10mg/ml (Furosemide, 2018).

Mechanism of Action

The drug inhibits reabsorption of water in the nephron. This is possible as the drug blocks N/K/2cl sodium-potassium-chloride cotransporter in the loop of Henle ascending limb. The competitive inhibition at the binding site at the cotransporter prevents transport of sodium from the loop of Henle into basolateral consequently the hypertonic condition is created in lumen while the interstitial turns out to be less hypertonic. Here the osmotic gradient of water reabsorption all through the nephron is diminished.

Medical Information

Discussion to find out if the patient has any medical condition will be helpful as the drug affects pregnancy, diabetes, kidney failure patients. Other factors will significantly determine the amount of dosage required for the patient, therefore before medication, the health information pertaining the patient should be disclosed (Adams, Holland & Urban, 2014).

Adverse Reaction

Common effects are dehydration, low blood pressure and depletion of the electrolyte like potassium and sodium. Other adverse effects include gastrointestinal reactions, for example, diarrhea, constipation, nausea, and anorexia and Systemic hypersensitivity reaction like interstitial nephritis. It also affects the central nervous system causing blurred vision, headaches and hearing loss. Notably, blood may react adversely causing anemia and leukopenia and skin reaction hypersensitivity of the skin, for example, itching, rash, and exfoliative dermatitis.

Dietary Restrictions

The patient should avoid alcohol. Additionally, he should limit the use of salt unless advised by the doctor and increase intake of food rich in potassium like bananas or orange juice.

Etiology of Heart Failure

The detection of diseases that cause heart failure is vital in the modification of the preventive as well as diagnostic and therapeutic approaches rendered the disease. Inpatient reports, any form of cardiac abnormality and HF risk factors should be outlined to help determine the prognosis. There are three leading causes of heart failure, and they are categorized to determining, predisposing and precipitating causal factors. Regarding predisposing factors, studies outline some etiological risk factors such as disorders of the coronary circulation, myocardium, peripheral vessels, pericardium, cardiac valves or the endocardium which result in the production of alterations in the heart's normal physiology. The main predisposing etiological factor is arterial hypertension, ordinarily prevalent amongst African-American individuals (Cubero, Rivera, Moral & Melchor, 2004). Other etiological risk factors include diabetes mellitus and rheumatic fever which frequently coexist with dyslipidemia or arterial hypertension, peripartum cardiomyopathy, pericardial disease, nutritional deficiencies, familial cardiomyopathy, tachycardia-induced cardiomyopathy, and systemic collagen vascular disorders. The investigation of etiology using specialized techniques may reveal the existence of genetic and family factors in some cases characterized by hypertrophic cardiomyopathy and restrictive cardiomyopathy that is often symptomatic of altered cardiac compliance (Cubero, Rivera, Moral & Melchor, 2004).

Left and Right-Sided Heart Failure and Their Differences, and Cardiovascular Changes That Occur in the Heart

Heart failure may involve the left, right or both sides of the heart; however, the left side occurs commonly, subsequently resulting in right-sided failure. The left-side heart failure can be classified into two types of heart failure: systolic and diastolic failure. Systolic failure entails malfunctioning of the left ventricle's muscle walls, consequently compromising the pumping action of the heart vessels, decreasing the ejection fraction slightly below normal ranges and in time, ventricle enlargement. On the other hand, diastolic heart failure entails the inability of the left ventricle muscle walls to relax voluntarily or generally as a result of muscle stiffening.

Conversely, the right-sided heart failure is often as a result of the left-side failing, increasing pressure on the heart's right side. With time, the right side of one's heart is progressively damaged and weakened, ensuing in loss of pumping power. As a result, blood is backed up in the circulatory system that supplies blood to the rest of the body, causing edema within the abdomen, around the liver and in one's limbs especially the feet, legs, and ankles.

Classification of Metoprolol, Dosage for Adults

Metoprolol is a beta 1-blocker, often considered as relatively selective as it is devoid of active intrinsic sympathomimetic activity. Characteristically, the drug has a weak membrane stabilizing ability. The dosage, for congestive heart failure, should be initiated at a low dosage ranging from 12.5-25mg once on a daily basis. This can be increased gradually at an interval of two weeks till such a time when the target dosage of 200mg once daily is achieved, or a patient under standard therapy for congestive heart failure attains maximal dosage tolerance (Prakash & Markham, 2000).

What to Know Regarding Treatment of Heart Failure With Metoprolol, Mechanism of Action, Available Routes of Administration

Metoprolol CR/XL has been proven to decrease mortality and improve the clinical status of patients with mild-moderate chronic heart failure (NYHA functional class 2 or 3) because of its systolic function in the left ventricular side of the heart. Furthermore, the drug effectively works on dilated or ischemic cardiomyopathy patients.

The patient can take the drugs at bedtime, with meals or in the morning. While food delays how the human body absorbs beta-blockers, it may also reduce the intensity of side effects, as such; the patient should strictly adhere to directions as guided on the drug label. Metoprolol should not be administered to a patient with hypotension or bradycardia as this may cause lightheadedness or dizziness. For patients with severe lung congestion, the physician should treat congestion prior to metoprolol prescription.

What the Patient Needs to Know About the Drug and Adverse Reactions

The doctor should direct the patient to record pulse rate daily while taking metoprolol and instruct the patient on the appropriate pulse rate when administering the drug. In that regard, the patient should be advised to call his doctor before taking the medication if the blood pressure records readings below 100 or a somewhat slower pulse rate (Adams, Holland & Urban, 2014).

Besides, the patient ought to understand that the heart-failure symptoms may seem worse at the beginning as the heart adjusts itself to the medication; hence the patient should never, at any given point, stop taking medicine before consulting with the doctor. However, it is advisable that the patient understands the importance of calling the doctor in cases of extreme fatigue, troubled breathing, or if the patient has other signs such as swelling, congestion or addition of more than five pounds (Jones & Bartlett Learning, 2018).

Some of the expected adverse reactions include lightheadedness or dizziness which often occurs when a patient is getting up from a chair or out of bed. Recent studies outline sudden weight gain as an adverse reaction, commonly evident as the doctor increases the medication dose. However, the patient should call his doctor if the weight gain persists for more than two days or if one gains more than 3 pounds a day. Common side effects include chest pain, swelling of lower legs and feet, skin rashes, wheezing, irregular heartbeat, trouble breathing, increasing breath shortness, heartburn, constipation or diarrhea, headache, fatigue as well as cold hands and feet.

References

Adams, M., Holland, L. N., & Urban, C. Q. (2014). Pharmacology for nurses: a pathophysiologic approach. 4th ed. Upper Saddle River, N.J.: Pearson.

Cubero, J. S., Rivera, L. A. P., Moral, R. P., & Melchor, L. S. (2004). Heart failure: etiology and approach to diagnosis. Revista espanola de cardiologia, 57(03), 250-259.

Furosemide (2018). Accessdata.fda.gov. Retrieved 15 October 2018, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018667s036lbl.pdf

Jones & Bartlett Learning. Nurse's Drug Handbook-seventeenth edition (2018).

Lisinopril (2018). Medicines.org.uk. Retrieved 15 October 2018, from https://www.medicines.org.uk/emc/files/pil.6074.pdf

Prakash A, Markham A. Metoprolol: a review of its use in chronic heart failure. Drugs. 2000 Sep;60 (3):647-78. PubMed PMID: 11030472.