NCLEX-PN® ExaminationPhysiological AdaptationMedium
A client with a history of heart failure is prescribed a new medication, sacubitril/valsartan (Entresto). The nurse should monitor for which adverse effect specific to this medication combination?
- AHypokalemia
- BDry cough
- CAngioedema
- DBradycardia
Show answer & explanationAnswer & explanation
Correct answer: C. Angioedema
Sacubitril/valsartan (Entresto) is a neprilysin inhibitor and angiotensin receptor blocker (ARNI). The neprilysin inhibition component can increase bradykinin levels, which is associated with a higher risk of angioedema, especially if combined with ACE inhibitors. Dry cough is associated with ACE inhibitors, not typically ARNIs. Hypokalemia is not a direct adverse effect, and bradycardia is not a primary concern with this medication.
Why the other options are wrong
- A. Hypokalemia is not a direct or common adverse effect; hyperkalemia is more likely due to the valsartan component.
- B. Dry cough is a common adverse effect of ACE inhibitors, which ARNIs replace, and is less common with sacubitril/valsartan.
- D. Bradycardia is not a primary or common adverse effect of sacubitril/valsartan; it primarily affects blood pressure and fluid balance.
Sacubitril/Valsartan (Entresto) Adverse Effects
Sacubitril/valsartan, an ARNI, effectively treats heart failure but carries a significant risk of angioedema due to increased bradykinin levels.
- Combines a neprilysin inhibitor (sacubitril) and an ARB (valsartan).
- Increases natriuretic peptides while blocking angiotensin II.
- Contraindicated with ACE inhibitors and within 36 hours of discontinuing an ACE inhibitor due to angioedema risk.
Memory trick: Angioedema's Alarm, Avoid ACE's Arm.