The respiratory therapist is asked to recommend a medication to reduce afterload for a patient with cardiogenic pulmonary edema. The therapist could recommend all of the following EXCEPT:
a. captopril.
b. norepinephrine (Levophed).
c. enalapril (Vasotec).
d. nitroprusside (Nitropress).
B
Afterload reducers include the following:
• captopril—prevents the conversion of angiotensin I to angiotensin II. It is a potent vasodilator. Afterload and cardiac output usually improve in 10 to 15 minutes.
• enalapril (Vasotec)—is a competitive ACE inhibitor and reduces angiotensin II levels.
• nitroprusside (Nitropress)—is a potent, direct smooth muscle-relaxing agent that primarily reduces afterload.
Norepinephrine (Levophed) may be used in the management of cardiogenic pulmonary edema; however, it is a positive inotropic agent, not an afterload reducer.
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