Which are potentially worrisome adverse effects associated with proton pump inhibitor use in older patients? (Select all that apply)

Choice A reason: Administering captopril risks angioedema, as the patient’s history of tongue and lip swelling with enalapril (another ACE inhibitor) suggests a class effect due to bradykinin accumulation. This is potentially life-threatening, requiring avoidance, not monitoring, making this choice unsafe and incorrect.

Choice B reason: Fosinopril, another ACE inhibitor, carries the same angioedema risk as captopril and enalapril due to similar bradykinin effects. Switching within the same drug class doesn’t address the patient’s history of adverse reactions, making this choice inappropriate and potentially dangerous.

Choice C reason: Holding captopril and notifying the provider is correct, as the patient’s history of angioedema with enalapril indicates a high risk with captopril, another ACE inhibitor. Alternative classes (e.g., ARBs) should be considered to avoid life-threatening reactions, making this the safest and correct action.

Choice D reason: Angioedema (tongue and lip swelling) is a serious, potentially fatal side effect of ACE inhibitors, not benign. Reassuring the patient minimizes the risk, which could delay intervention. The history warrants avoiding captopril and consulting the provider, making this choice incorrect and unsafe.

Choice A reason: A sodium level of 140 mEq/L is within the normal range (135-145 mEq/L). While furosemide can cause hyponatremia, this value is not concerning. Hypokalemia is a greater risk with furosemide and digoxin, as it potentiates digoxin toxicity, making this choice less critical than potassium.

Choice B reason: Oxygen saturation of 95% is normal (95-100%). Crackles suggest pulmonary edema, but this saturation doesn’t indicate severe hypoxia requiring immediate action. Hypokalemia poses a greater risk with digoxin and furosemide, as it increases toxicity potential, making this choice less concerning.

Choice C reason: A potassium level of 3.0 mEq/L (normal: 3.5-5.0 mEq/L) indicates hypokalemia, exacerbated by furosemide’s diuretic effect. In digoxin use, low potassium increases cardiac toxicity risk, causing arrhythmias, especially with an irregular heart rate noted, making this the most concerning value requiring immediate attention.

Choice D reason: A blood glucose level of 100 mg/dL is normal (70-110 mg/dL fasting). It’s unrelated to digoxin or furosemide’s primary risks (e.g., electrolyte imbalances, arrhythmias). Hypokalemia is a more immediate concern due to its synergistic toxicity with digoxin, making this choice less critical.