Which of the following changes in the client’s health status may require a change to the prescription for benazepril?
a. The client’s creatinine clearance is steadily declining
b. The client is treated for hepatitis A
c. The client is diagnosed with depression and begins taking a selective serotonin reuptake inhibitor (SSRI) d. The client is diagnosed with gastroesophageal reflux disease (GERD)
The correct answer and explanation is:
Correct Answer: a. The client’s creatinine clearance is steadily declining
Benazepril is an angiotensin-converting enzyme (ACE) inhibitor used to manage hypertension and sometimes heart failure. It works by relaxing blood vessels, thereby lowering blood pressure and decreasing the workload on the heart. It is primarily excreted by the kidneys. As a result, kidney function plays a critical role in how the body clears the drug.
When a client’s creatinine clearance is steadily declining, this signals worsening kidney function. Since benazepril is excreted by the kidneys, impaired renal function can lead to accumulation of the drug in the body. This may increase the risk of adverse effects such as hyperkalemia (high potassium), hypotension (low blood pressure), and worsening renal function. Therefore, the dosage of benazepril may need to be reduced or the medication may need to be discontinued altogether in such cases. Monitoring kidney function is essential for clients taking ACE inhibitors.
Option b, hepatitis A, affects the liver but does not typically interfere with benazepril metabolism, which is primarily renal, not hepatic. Therefore, this condition is not a reason to change the prescription.
Option c, starting a selective serotonin reuptake inhibitor (SSRI), does not significantly interact with benazepril. There is minimal pharmacokinetic or pharmacodynamic interaction between the two drug classes, so no adjustment in benazepril dosage is generally required.
Option d, a diagnosis of GERD, does not alter kidney function and does not typically interact with benazepril. Medications used to treat GERD, such as proton pump inhibitors or antacids, have little to no interaction with benazepril.
In summary, declining renal function is a key indicator that the benazepril prescription may need to be adjusted to prevent toxicity and complications.