Prazosin (Minipress) is prescribed for hypertensive client. Which measure should be used by the nurse to prevent the first-dose phenomenon?
1. Give the dosage early in the morning before breakfast.
2. Give initial low doses at bedtime.
3. Give the dosage with meals.
4. Give initial high dosage and then lower gradually.
Correct Answer: 2
Rationale 1: Prazosin (Minipress) should be given at bedtime, not early in the morning before breakfast, because dizziness and headaches can continue through the day.
Rationale 2: First-dose syncope with sudden loss of consciousness generally occurs 30 to 90 minutes after an initial dose of 2 mg or more. This can cause a sudden fall in blood pressure, so the initial low doses of 1 mg must be given at bedtime.
Rationale 3: The first-dose phenomenon occurs even when prazosin (Minipress) is given with meals.
Rationale 4: Giving initial high dosage and then lowering the dose gradually does not prevent the first-dose phenomenon.
Global Rationale: First-dose syncope with sudden loss of consciousness generally occurs 30 to 90 minutes after an initial dose of 2 mg or more. This can cause a sudden fall in blood pressure, so the initial low doses of 1 mg must be given at bedtime. Prazosin (Minipress) should be given at bedtime, not early in the morning before breakfast, because dizziness and headaches can continue through the day. The first-dose phenomenon occurs even when prazosin (Minipress) is given with meals. Giving initial high dosage and then lowering the dose gradually does not prevent the first-dose phenomenon.
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