A patient with peripheral vascular disease has been on pentoxifylline (Trental) for 2 weeks.

Which statements by the patient indicate no need for further patient teaching about the disease? Select all that apply.

ACE inhibitors are a type of medication used to treat high blood pressure and heart failure. They work by blocking the production of a hormone called angiotensin II, which narrows the blood vessels and increases blood pressure.By preventing this hormone from acting, ACE inhibitors lower blood pressure and reduce the workload on the heart. One of the most common side effects of ACE inhibitors is a dry cough, which occurs in 12–19% of people who take them. The cough is caused by the accumulation of a substance called bradykinin, which is normally broken down by angiotensin-converting enzyme (ACE).When ACE is inhibited, bradykinin levels increase and cause irritation and inflammation in the airways.

Choice A is wrong because decreased white blood cells are not a common side effect of ACE inhibitors.

However, some people may develop a condition called neutropenia, which is a low level of a type of white blood cell called neutrophils.This can increase the risk of infections and may require stopping the medication.

Choice B is wrong because swelling of the face and lips is not a common side effect of ACE inhibitors.

However, some people may develop a rare but serious allergic reaction called angioedema, which is a swelling of the deeper layers of the skin and mucous membranes.

This can affect the face, lips, tongue, throat, or other parts of the body and can cause difficulty breathing or swallowing.Angioedema can be life-threatening and requires immediate medical attention.

Choice D is wrong because renal failure is not a common side effect of ACE inhibitors.

However, some people may experience a decrease in kidney function or an increase in blood levels of creatinine, which is a waste product filtered by the kidneys.

Diuretics are drugs that increase the amount of urine and salt (sodium) excreted by the kidneys. They are used to treat high blood pressure, heart failure, and edema (fluid retention). However, some diuretics can cause low levels of potassium in the blood (hypokalemia), which can lead to muscle weakness, cramps, and arrhythmias. To prevent this, a combination of diuretics acting on different parts of the kidney (such as a loop diuretic and a thiazide diuretic) may be prescribed.This way, the potassium-sparing effect of one diuretic can balance the potassium-wasting effect of the other, while still achieving a net sodium loss.

Choice A is wrong because they are not a part of the initial diuretic therapy.Combination diuretic therapy is usually reserved for patients who are resistant to or intolerant of monotherapy.

Choice C is wrong because little follow up is not needed after the initial treatment.Patients on combination diuretic therapy require close monitoring of their blood pressure, electrolytes, renal function, and weight to avoid adverse effects such as dehydration, hyponatremia, hypotension, and worsening renal function.

Choice D is wrong because they do not increase the risk of hypokalemia.As explained above, combination diuretic therapy aims to reduce the risk of hypokalemia by using a potassium-sparing diuretic along with a potassium-wasting diuretic.