Complete the statement about the newly entered heart-failure medication order.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Sacubitril/valsartan is contraindicated with concomitant ACE inhibitor use. A 36-hour washout is required when switching from lisinopril or another ACE inhibitor.
Quick answer Hold and clarify the sacubitril/valsartan order, then verify a start time at least 36 hours after the last lisinopril dose.
Why this is correct Lisinopril is an ACE inhibitor. DailyMed states that sacubitril/valsartan must not be used concomitantly with an ACE inhibitor and requires a 36-hour washout when switching.
Easy analogy or mental picture Picture two trains sharing a tunnel. The ACE inhibitor must fully clear the scheduled tunnel before sacubitril/valsartan enters.
Memory hook ACE inhibitor to ARNI: separate by 36 hours.
NCLEX decision rule Before administering a newly substituted cardiovascular medication, reconcile the last dose and required washout. Do not shorten a labeled safety interval because vital signs are stable.
Why the other choices are wrong Immediate coadministration violates the contraindication. Waiting only until the next routine medication pass is not the required interval, and permanently discontinuing both drugs is not the nurse's independent decision.
References
1DailyMed: EntrestoACE inhibitor contraindication and 36-hour washout
Interaction checkVerify the exact last ACE inhibitor dose and the scheduled first sacubitril/valsartan dose before administration.