smaller rise in serum [K ϩ ], 0.12 mEq/L above baseline (P ϭ ACE inhibition or angiotensin receptor blockade: Impact on 0.1), a 43% lower value when compared with the change in potassium in renal failure. those who received lisinopril. This blunted rise in [K ϩ ] in people Background. Inhibition of the renin-angiotensin system is taking valsartan was not associated with a significant decrease known to raise serum potassium [K ϩ ] levels in patients with in plasma aldosterone (P ϭ 0.14). renal insufficiency or diabetes. No study has evaluated the Conclusions. In the presence of renal insufficiency, the ARB comparative effects of an angiotensin-converting enzyme valsartan did not raise serum [K ϩ ] to the same degree as the (ACE) inhibitor versus an angiotensin receptor blocker (ARB) ACE inhibitor lisinopril. This differential effect on serum [K ϩ ] on the changes in serum [K ϩ ] in people with renal insufficiency. is related to a relatively smaller reduction in plasma aldoste-Methods. The study was a multicenter, randomized, double rone by the ARB and is not related to changes in GFR. This crossover design, with each period lasting one month. A total study provides evidence that increases in serum [K ϩ ] are less of 35 people (21 males and 14 females, 19 African Americans likely with ARB therapy compared with ACE inhibitor therapy and 16 Caucasian) participated, with the mean age being 56 Ϯ in people with renal insufficiency. 2 years. Mean baseline serum [K ϩ ] was 4.4 Ϯ 0.1 mEq/L. The glomerular filtration rate (GFR) was 65 Ϯ 5 mL/min/1.73 m 2 , and blood pressure was 150 Ϯ 2/88 Ϯ 1 mm Hg. The main outcome measure was the difference from baseline in the level Drug-induced hyperkalemia, that is, serum potassium of serum [K ϩ ], plasma aldosterone, and GFR following the Ͼ5.5 mEq/L, is an important but often overlooked probinitial and crossover periods. Results. For the total group, serum [K ϩ ] changes were not lem encountered commonly in clinical practice. Medicasignificantly different between the lisinopril or valsartan treattions generally produce hyperkalemia either by causing ments. The subgroup with GFR values of Յ60 mL/min/1.73 redistribution of potassium (␤ 2-adrenergic blockers, sucm 2 who received lisinopril demonstrated significant increases cinylcholine, digitalis overdose, hypertonic mannitol) or in serum [K ϩ ] of 0.28 mEq/L above the mean baseline of by impairing renal potassium excretion. Drugs such as 4.6 mEq/L (P ϭ 0.04). This increase in serum [K ϩ ] was also accompanied by a decrease in plasma aldosterone (P ϭ 0.003). nonsteriodal anti-inflammatory drugs (NSAIDs), inhibi-Relative to the total group, the change in serum [K ϩ ] from tors of the renin-angiotensin-aldosterone (RAA) system, baseline to post-treatment in the lisinopril group was higher heparin, and cyclosporine impair renal potassium excreamong those with GFR values of Յ60 mL/min/1.73 m 2. The tion by interfering with the production and/or secretion lower GFR group taking valsartan, however, demonstrated a of aldosterone [1]. Renal in...

In the presence of renal insufficiency, the ARB valsartan did not raise serum [K(+)] to the same degree as the ACE inhibitor lisinopril. This differential effect on serum [K(+)] is related to a relatively smaller reduction in plasma aldosterone by the ARB and is not related to changes in GFR. This study provides evidence that increases in serum [K(+)] are less likely with ARB therapy compared with ACE inhibitor therapy in people with renal insufficiency.

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Purpose Faculty members across the country are faced with integrating gerontological content and competencies across advanced practice registered nurse (APRN) programs that focus on the adult‐gerontology population. The purpose of this initiative was to effectively and efficiently integrate gerontological content into the adult management courses for several APRN programs in acute and primary care at one university's college of nursing. Data sources Current literature, resources for integrating adult‐gerontology content, course evaluations, and end of program surveys were used in this project. Conclusion This curricular update effectively utilized resources and engaged faculty across programs to infuse gerontological content into the adult management courses. Students from multiple programs sharing these courses benefited from gerontological lecturers, content, and learning activities. The content gaps were integrated into existing courses rather than developing a new course. Current outcome data reflect this was an effective curricular change. Implications for practice In conjunction with meeting national requirements for integrating adult‐gerontology content into APRN curriculum, APRNs prepared with enhanced gerontological knowledge and skills build a workforce that is competent to improve care for older adults across the continuum of care.