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Incorporeal Movement: The ghost can move through other creatures and Objects as if they were Difficult Terrain. It takes 5 (1d10) force damage if it ends its turn inside an object.
: The ghost enters the Ethereal Plane from The Material Plane, or vice versa. It is visible on The Material Plane while it is in the Border Ethereal, and vice versa, yet it can't affect or be affected by anything on the other plane.
Horrifying Visage: Each non-undead creature within 60 ft. of the ghost that can see it must succeed on a DC 13 Wisdom saving throw or be Frightened for 1 minute. If the save fails by 5 or more, the target also ages 1d4 x 10 years. A Frightened target can repeat the saving throw at the end of each of its turns, ending the Frightened condition on itself on a success. If a target's saving throw is successful or the effect ends for it, the target is immune to this ghost's Horrifying Visage for the next 24 hours. The aging effect can be reversed with a Greater Restoration spell, but only within 24 hours of it occurring.
Possession (Recharge 6): One Humanoid that the ghost can see within 5 ft. of it must succeed on a DC 13 Charisma saving throw or be possessed by the ghost; the ghost then disappears, and the target is Incapacitated and loses control of its body. The ghost now controls the body but doesn't deprive the target of awareness. The ghost can't be targeted by any Attack, spell, or other effect, except ones that turn Undead, and it retains its Alignment, Intelligence, Wisdom, Charisma, and immunity to being Charmed and Frightened. It otherwise uses the possessed target's Statistics, but doesn't gain access to the target's knowledge, Class Features, or Proficiencies.
The possession lasts until the body drops to 0 Hit Points, the ghost ends it as a Bonus Action, or the ghost is turned or forced out by an effect like the Dispel Evil and Good spell. When the possession ends, the ghost reappears in an unoccupied space within 5 ft. of the body. The target is immune to this ghost's Possession for 24 hours after succeeding on the saving throw or after the possession ends.
. If possible, discontinue diuretics 2 to 3 days before ramipril therapy begins to prevent severe hypotension. If patient can't swallow capsule, open it and mix contents in water or apple juice or sprinkle in small amount of applesauce. Know that drug may be used alone or with other antihypertensives. Feb 03, 2020 Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 28 Feb 2020), Cerner Multum™ (updated 2 Mar 2020). The force index is a technical indicator that measures the amount of power used to move the price of an asset. The term and its formula were developed by psychologist and trader Alexander Elder.
Also found in: Dictionary, Thesaurus.Related to Delix: Ramipril
ramipril
[rah-mi´pril]an angiotensin-converting enzyme inhibitor used in treatment of hypertension and congestive heart failure; administered orally.
ramipril
Altace, Apo-Ramipril (CA), Co Ramipril (CA), Lopace (CA), Novo-Ramipril*, Ratio-Ramipril (CA), Sandoz Ramipril (CA), Tritace (UK)
Pharmacologic class: Angiotensinconverting enzyme (ACE) inhibitor
Therapeutic class: Antihypertensive
Pregnancy risk category D
Action
Inhibits conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Increases plasma renin levels and reduces aldosterone levels, causing systemic vasodilation and decreased cardiac output.
Availability
Capsules: 1.25 mg, 2.5 mg, 5 mg, 10 mg
Indications and dosages
➣ Hypertension
Adults: Initially, 2.5 mg P.O. daily in patients not receiving diuretics; may increase dosage slowly p.r.n. according to response. For maintenance, 2.5 to 20 mg/day P.O. as a single dose or in two equally divided doses. If ramipril alone doesn't control blood pressure, a diuretic may be added.
➣ To reduce the risk of myocardial infarction (MI), cerebrovascular accident, or death from cardiovascular causes
Adults: Initially, 2.5 mg P.O. daily for 1 week, followed by 5 mg P.O. daily for the next 3 weeks, then increased as tolerated to a maintenance dosage of 10 mg P.O. daily. In hypertensive patients and those who've had a recent MI, may divide maintenance dose.
➣ Heart failure after MI
Adults: Initially, 2.5 mg P.O. b.i.d.; may decrease to 1.25 mg b.i.d. if higher dosage causes hypotension. Titrate toward target dosage of 5 mg b.i.d. at 3-week intervals.
Dosage adjustment
• Renal impairment
• Concurrent diuretic use
Off-label uses
• Angina associated with syndrome X
• Atherosclerosis
• Mitral insufficiency
• Renovascular hypertension
• Diabetic or nondiabetic nephropathy
• Erythrocytosis
Contraindications
• Hypersensitivity to drug or other ACE inhibitors
• Angioedema with previous ACE inhibitor use or history of hereditary or idiopathic angioedema
Precautions
Use cautiously in:
• autoimmune diseases, aortic stenosis, hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency, collagen vascular disease, febrile illness, hepatic or renal impairment, hypotension, neutropenia, chronic cough, proteinuria, renal artery stenosis
• risk factors for development of hyperkalemia (including renal insufficiency, diabetes mellitus, concurrent use of potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes)
• family history of angioedema
• concurrent immunosuppressant or diuretic therapy
• black patients
• elderly patients
• pregnant patients
• breastfeeding patients (avoid use)
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• children (safety not established).
Administration
• If possible, discontinue diuretics 2 to 3 days before ramipril therapy begins to prevent severe hypotension.
• If patient can't swallow capsule, open it and mix contents in water or apple juice or sprinkle in small amount of applesauce.
• Know that drug may be used alone or with other antihypertensives.
Adverse reactions
CNS: dizziness, light-headedness, fatigue, headache, vertigo, asthenia
CV: hypotension, orthostatic hypotension, angina pectoris, tachycardia, MI, heart failure
EENT: blurred vision, sinusitis
GI: nausea, vomiting, diarrhea
Hematologic: purpura, agranulocytosis
Metabolic: hyperkalemia
Musculoskeletal: muscle cramps
Respiratory: cough, asthma, upper respiratory tract infection, bronchospasm
Skin: rash, pruritus, urticaria, photosensitivity, angioedema, anaphylactoid reactions
Other: fever
Interactions
Drug-drug.Diuretics, other antihypertensives: increased hypotension
Gold (sodium aurothiomalate): increased risk of rare nitritoid reactions (including facial flushing, nausea, vomiting, and hypotension)
Lithium: increased lithium blood level and risk of toxicity
Nonsteroidal anti-inflammatory drugs: may result in deterioration of renal function, including acute renal failure and attenuated ACE inhibitor antihypertensive effect
Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia
Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, potassium: increased levels
Drug-food.Any food: decreased rate (but not extent) of drug absorption Salt substitutes containing potassium: increased risk of hyperkalemia
Patient monitoring
• Assess vital signs and cardiovascular status. Ask patient if he's experiencing angina.
• Monitor CBC and liver function tests.
• Closely monitor potassium level. Watch for signs and symptoms of hyperkalemia.
☞ Stay alert for signs and symptoms of hypersensitivity reactions (including angioedema), especially in black patients after first dose
• Evaluate for dry, nonproductive cough.
Patient teaching
• Tell patient he may take with or without food.
☞ Instruct patient to immediately report swelling of tongue or face or difficulty breathing.
• Teach patient how to monitor and record blood pressure.
• Tell patient drug may cause dry, nonproductive cough. Instruct him to report this problem if it becomes bothersome.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.
• Inform patient that excessive fluid loss (as from sweating, vomiting, or diarrhea) and inadequate fluid intake increase risk of light-headedness (especially in hot weather).
• Tell patient to avoid salt substitutes containing potassium.
• Advise female patient to tell prescriber if she is pregnant. Caution her not to take drug during third trimester or when breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.
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ramipril
An ANGIOTENSIN CONVERTING ENZYME inhibitor drug that has been shown to be capable of greatly extending life after heart attack. The drug is especially useful in the condition of dilated cardiomyopathy and in reducing the risk of heart attack and stroke in predisposed persons. A brand name is Tritace.Want to thank TFD for its existence? Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content.
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Traits
Ethereal Sight: The ghost can see 60 ft. into the Ethereal Plane when it is on The Material Plane, and vice versa.Incorporeal Movement: The ghost can move through other creatures and Objects as if they were Difficult Terrain. It takes 5 (1d10) force damage if it ends its turn inside an object.
Actions
Withering Touch: Melee Weapon Attack: +5 to hit, reach 5 ft., one target. Hit: 17 (4d6 + 3) necrotic damage.: The ghost enters the Ethereal Plane from The Material Plane, or vice versa. It is visible on The Material Plane while it is in the Border Ethereal, and vice versa, yet it can't affect or be affected by anything on the other plane.
Horrifying Visage: Each non-undead creature within 60 ft. of the ghost that can see it must succeed on a DC 13 Wisdom saving throw or be Frightened for 1 minute. If the save fails by 5 or more, the target also ages 1d4 x 10 years. A Frightened target can repeat the saving throw at the end of each of its turns, ending the Frightened condition on itself on a success. If a target's saving throw is successful or the effect ends for it, the target is immune to this ghost's Horrifying Visage for the next 24 hours. The aging effect can be reversed with a Greater Restoration spell, but only within 24 hours of it occurring.
Possession (Recharge 6): One Humanoid that the ghost can see within 5 ft. of it must succeed on a DC 13 Charisma saving throw or be possessed by the ghost; the ghost then disappears, and the target is Incapacitated and loses control of its body. The ghost now controls the body but doesn't deprive the target of awareness. The ghost can't be targeted by any Attack, spell, or other effect, except ones that turn Undead, and it retains its Alignment, Intelligence, Wisdom, Charisma, and immunity to being Charmed and Frightened. It otherwise uses the possessed target's Statistics, but doesn't gain access to the target's knowledge, Class Features, or Proficiencies.
The possession lasts until the body drops to 0 Hit Points, the ghost ends it as a Bonus Action, or the ghost is turned or forced out by an effect like the Dispel Evil and Good spell. When the possession ends, the ghost reappears in an unoccupied space within 5 ft. of the body. The target is immune to this ghost's Possession for 24 hours after succeeding on the saving throw or after the possession ends.