A patient with heart failure tells the nurse that she is "allergic" to ACE inhibitors because they make her cough "all of the time.". Which of the following does this information suggest to the nurse?
1. The patient should not take an angiotensin receptor blocker because of the ACE inhibitor allergy.
2. The patient experienced a side effect of the ACE inhibitor which is a cough.
3. The patient has asthma and not an allergy to ACE inhibitors.
4. The patient has long standing heart failure which is the cause of her cough.
2
Rationale: One of the most important concepts for patients to understand is the difference between a drug side effect and a drug allergy. A drug allergy refers to some display of anaphylactic shock, such as a rash, airway compromise, or hypotension. A drug side effect is a reaction to some action of the drug other than anaphylaxis. A patient may say that he or she has an allergy to a drug but it is really a side effect. The patient thinks that he or she has an allergy to ACE inhibitors because they developed a cough. Cough is really a side effect of ACE inhibitors, not an allergy. Coughing is the result of the release of kinins that cause coughing with prolonged therapy. Patients who cannot tolerate ACE inhibitors often are prescribed angiotensin receptor blockers since they do not cause the side effect of a cough. There is no evidence to suggest that the patient has asthma or that the cause of the cough is the patient's heart failure.
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