OK, I am doing home health, and I have a question.
Ordinarily, I expect a pt to be on one kind of med per category. Eg, if I got into a home and pt has Lopressor and Toprol XL and is taking both, it is pretty easy to figure out why they have been dizzy, fell and have a slow HR!
I have had to thin out many people's meds in this way, taking 2 and sometimes 3 diff types of same category cardiac med.
So, now we come to ACE-I's and ARB's. I understand that of these categories work on a different part of the pathway of the renin-angiotensin system. The ARB's result in less cough as S/E. But what about the potential for renal failure.
I realize these agencts are cardioprotective in the long run, but I am concerend about the potential for renal failure, esp in the elderly. I have seen quite a few pt's end up with serious elevations of BUN/Creat from the ACE-I's.
My questions are these...
Is the potential for Renal Failure as high w ARB as it is w ACE-I's?
AND, isn't it overkill to have people on a drug in each of these categories at the same time?? I am seeing this more often, and can't get straight answer on this. Is it appropriate to treat pt w ACE-I and ARB simultaneously??
My gut says pick one, have their not been enough studies??
Thanks for your input.