Hydrochlorothiazide Enalapril

PE Vitals HR 85 beats/min, RR 14 breaths/min. Medications Omeprazole, enalapril, hydrochlorothiazide, acetaminophen. Metoprolol was initiated. 

ACE Inhibitor/Diuretic benazepril/hydrochlorothiazide, captopril/hydrochlorothiazide, enalapril/hydrochlorothiazide, fosinopril/hydrochlorothiazide, iisinoprii/hydrochiorothiazide, moexiprii/hydrochiorothiazide, and quinaprii/hydrochiorothiazide ACE Inhibitor/Calcium Channel Blocker benazeprii/amiodipine, enaiaprii/feiodipine, trandoiaprii/verapamii... 

Nitrendipine. A post-hoc analysis of the Syst-Eur trial of nitrendipine-based antihypertensive treatment found no difference in cardiovascular outcome between 861 patients who were also using long-term aspirin (700 patients) and/or other NSAIDs (161) and 2882 patients who had never taken aspirin or NSAIDs. Patients in this trial were randomised to receive nitrendipine, which could be combined or replaced by enalapril, hydrochlorothiazide, or both. ... 

Hydroserpine 2 Tablets—hydrochbrothiazide, reserpine Hyzaar—hydrochlorothiazide, losartan potassium Inderide—hydrochlorotliiazide, propranolol HC1 Inderide LA—hydrochlorotliiazide, propranolol HC1 Lexxel Extended-Release—enalapril maleate, felodipine Lopressor—hydrochlorothiazide, metoprolol Lotensin HCT—hydrochlorothiazide, benazepril Lotrel—amlodopine, benazepril... 

Uniretic—hydrochlorotliiazide, moexipril HC1 Vaseretic—hydrochlorotliiazide, enalapril maleate Zestoretic—hydrochlorotliiazide, lisinopril Ziac—hydrochlorothiazide, bisoprolol fumarate... 

Figure 6.3 Plot of the fraction of dose absorbed (in %) of various drugs as a function of the permeability estimates in the Caco-2 system. Key 1 D-glucose 2 verapamil 3 piroxicam 4 phenylalanine 5 cyclosporin 6 enalapril 7 cephalexim 8 losartan 9 lisinopril 10 amoxicillin 11 methyldopa 12 naproxen 13 an-tipyrine 14 desipramine 15 propanolol 16 amiloride 17 metoprolol 18 terbu-taline 19 mannitol 20 cimetidine 21 ranitidine 22 enalaprilate 23 atenolol 24 hydrochlorothiazide.

Correct answer = C. Clonidine reduces sympathetic outflow by stimulating a-adrenergic receptors. Minoxidil is a direct-acting vasodilator. Verapamil causes vasodilation by inhibiting calcium ion flow into smooth muscle. Enalapril blocks the enzyme that converts angiotensin I to angiotensin II. Hydrochlorothiazide acts by decreasing blood volume. 

PORFIMER I. ACE INHIBITORS -enalapril 2. ANALGESICS -celecoxib, ibuprofen, ketoprofen, naproxen 3. ANTIARRHYTHMICS — amiodarone 4. ANTIBIOTICS -ciprofloxacin, dapsone, sulphonamides, tetracyclines 5. ANTICANCER AND IMMUNOMODULATING DRUGS -fluorouracil (topical and oral) 6. ANTIDIABETIC DRUGS-glipizide 7. ANTIMALARIALS -hydroxychloroquine, quinine 8. ANTIPSYCHOTICS -chlorpromazine, fluphenazine 9. CALCIUM CHANNEL BLOCKERS - diltiazem 10. DIURETICS -bumetanide, furosemide, hydrochlorothiazide II. PARA-AMINOBENZOIC ACID (TOPICAL) 12. RETINOIDS-acitretin, isotretinoin 13. SALICYLATES (TOPICAL) t risk of photosensitivity reactions Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

Philipp T, Anlauf M, Distler A, Holzgreve H, Michaelis J, Wellek S. Randomised, double bhnd, multicentre comparison of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in antihypertensive treatment results of the HANE study. HANE Trial Research Group. BMJ 1997 315(7101) 154-9. 

Helgoland A, Strommen R, Hagelund CH, Tretli S. Enalapril, atenolol, and hydrochlorothiazide in mild to moderate hypertension. A comparative multicentre study in general practice in Norway. Lancet 1986 l(8486) 872-5. 

Franklin SS, Smith RD. A comparison of enalapril plus hydrochlorothiazide with standard triple therapy in renovascular hypertension. Nephron 1986 44 (suppi 1) 73-82. 

HPI AV is a 62-year-old white man with a 6-year history of HTN. His current antihypertensive therapy consists of enalapril and hydrochlorothiazide, but AV s BP is still elevated at 165/94 mm Hg. PMH COPD, peptic ulcer disease (PUD), HTN, and chronic back pain. 

Note Lexxel is enalapril and felodipine Teczem is enalapril and diltiazem Vaseretic is enalapril and hydrochlorothiazide... 

Antiviral agents acyclovir, amantadine, azidofhymidine Diuretics furosemide, hydrochlorothiazide, efhacrynic acid ACE inhibitors captopril, enalapril, ramipril, delapril, quinapril Antineoplastics methotrexate, azathioprine, doxorubicin, 5-fluouracil Antiepileptics valproic acid (from Ref. [95])... 

Enalapril is an antihypertensive combination. Enalapril causes vasodilation and decreased BP hydrochlorothiazide... 

Noninterfering acebutolol, brefanolol, carteolol, carvedilol, enalapril, furosemide, hydrochlorothiazide, isosorbide dinitrate, metoprolol, nifedipine, piretanide, propranolol, verapamil, xamoterol, xipamide... 

Uniretic— liydrochlorotliiazide, moexipril HCl Vaseretic—liydrochlorotliiazide enalapril maleate Zestoretic—liydrochlorotliiazide lisinopril Ziac— hydrochlorothiazide, bisoprolol fumarate... 

X 10 M), which is one of the most active ACE inhibitors. Enalaprilat causes a drop in blood pressure, as does captoprU. Enalapril is widely used to treat hypertension and congestive heart failure, and is available alone and in combination with hydrochlorothiazide. Enalapril was approved for marketing by the EDA in December 1985 [A. A. Patchett et al.. Nature 1980, 288, 280 E. H. Ulm, Drug Metab. Rev. 1983, 14, 99]. 

The risk of ACE inhibitor-induced renal impairment in patients with or without renovascular disease can be potentiated by diuretics. " In an analysis of 74 patients who had been treated with captopril or lisinopril, reversible acute renal failure was more coimnon in those who were also treated with a diuretic (furosemide and/or hydrochlorothiazide) than those who were not (11 of 33 patients compared with 1 of 41 patients). Similarly, in a prescription-event monitoring study, enalapril was associated with raised creatinine or urea in 75 patients and it was thought to have contributed to the deterioration in renal function and subsequent deaths in 10 of these patients. However, 9 of these 10 were also receiving loop or thiazide diuretics, sometimes in high doses. Retrospective analysis of a controlled study in patients with hypertensive nephrosclerosis identified 8 of 34 patients who developed reversible renal impairment when treated with enalapril and various other antihypertensives including a diuretic (furosemide or hydrochlorothiazide). In contrast, 23 patients treated with placebo and various other antihypertensives did not develop renal impairment. Subsequently, enalapril was tolerated by 7 of the 8 patients without deterioration in renal function and 6 of these patients later received diuretics. One patient was again treated with enalapril with recurrence of renal impairment, but discontinuation of the diuretics (furosemide, hydrochlorothiazide, and triamterene) led to an improvement in renal function despite the continuation of enalapril. ... 

Weisser K, Schloos J, Jakob S, Muhlberg W, Platt D, MutscWer E. The influence of hydrochlorothiazide on the pharmacokinetics of enalapril in elderly patients. EurJ Clin Pharmacol... 

In one study, sulindac 200 mg twice daily given to patients taking capto-pril 100 to 200 mg twice daily caused only a small rise in blood pressure (from 132/92 to 137/95 mmHg). Sulindac 150 mg twice daily did not attenuate the blood pressure response to captopril when it was substituted for ibuprofen in an elderly woman. Similarly, sulindac 200 mg twice daily did not blunt the antihypertensive effect of enalapril in 9 patients with hypertension. Two studies in black women also found that sulindac 200 mg twice daily for one month did not alter the antihypertensive effect of fosinopril 10 to 40 mg daily or lisinopril 10 to 40 mg daily (given with hydrochlorothiazide 25 mg daily). - ... 

In a handful of ca e, patients taking enalapril and/or losartan and other antihypertensive drugs (amlodipine, atenolol, hydrochlorothiazide) had marked increases in blood pressure, hypertensive crises and, in one case, intracranial haemorrhage, within 7 to 60 days of starting orlistat. 

A retrospective analysis of 14 patients without renal impairment taking potassium supplements and either furosemide or hydrochlorothiazide, found that the levels of serum potassium, during a 4-year period, had not significantly increased after the addition of captopril. Another study in 6 healthy subjects found that intravenous potassium chloride caused virtually the same rise in serum potassium levels in those given enalapril as in those given a placebo. ... 

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