Pharmacological and Parenteral Therapies Q 17

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The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should:

  

     A. Question the order

     B. Administer the medications

     C. Administer separately

     D. Contact the pharmacy

    

    

Correct Answer: B. Administer the medications

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Zestril is an ACE inhibitor and is frequently given with a diuretic such as Lasix for hypertension. Studies of hypertension confirm that ACE inhibitors enhance the antihypertensive effects of diuretics, though the interaction appears more additive than synergistic. Combining diuretics with ACE inhibitors appear to be no more effective than combining them with beta blockers.

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Option A: Diuretics and angiotensin-converting enzyme (ACE) inhibitors are commonly used in combination, both for patients with heart failure and for those with hypertension.

Option C: Diuretics activate the renin–angiotensin–aldosterone (RAAS) system that may limit the effects of diuretics on vascular tone and sodium excretion, which in turn, may limit their efficacy in reducing arterial pressure or in improving the symptoms of heart failure. ACE inhibitors can reduce plasma concentrations of angiotensin II and aldosterone, providing a theoretical rationale for use in combination with a diuretic.

Option D: The order is accurate. There is no need to question the order, administer the medication separately, or contact the pharmacy. When used in combination, the thiazide diuretics and the angiotensin-converting enzyme inhibitors have been shown to improve blood pressure reduction over either drug used alone.

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