A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to:
a. report wheezing and shortness of breath, which may occur with these drugs.
b. take care when getting out of bed or a chair after the first dose of the ACE inhibitor.
c. discuss taking an increased dose of the thiazide diuretic with the cardiologist.
d. minimize fluid intake for several days when beginning therapy with the ACE inhibitor.
B
ACE inhibitors have a first-dose effect that may cause a precipitous symptomatic fall in blood pressure, particularly in patients receiving diuretics. The patient should be counseled about rising quickly from sitting or lying down. Wheezing and shortness of breath are unlikely. An increased dose of diuretic and a reduction in fluid intake are not indicated and may add to hypotension.
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