Home Drug Guide Lisinopril

Drug Guide

Generic Name

Lisinopril

Brand Names Prinivil, Zestril, Qbrelis

Classification

Therapeutic: Antihypertensive, Heart failure agent

Pharmacological: ACE inhibitor (Angiotensin-Converting Enzyme Inhibitor)

FDA Approved Indications

  • Hypertension
  • Acute myocardial infarction (to improve survival after MI)
  • Heart failure (with reduced ejection fraction)

Mechanism of Action

Lisinopril inhibits the angiotensin-converting enzyme (ACE), decreasing the formation of angiotensin II, leading to vasodilation, reduced blood pressure, and decreased afterload and preload in heart failure.

Dosage and Administration

Adult: Typically 10-40 mg once daily for hypertension; dose may be adjusted based on response.

Pediatric: Dosing varies; generally starts at 0.07 mg/kg once daily, adjusted based on response.

Geriatric: Start at lower doses due to increased risk of hypotension and renal impairment; typical starting dose 5 mg once daily.

Renal Impairment: Reduce dose or increase dosing interval based on severity of impairment.

Hepatic Impairment: Use with caution; no specific dose adjustment indicated.

Pharmacokinetics

Absorption: Well absorbed orally; peak plasma levels reached in about 6 hours.

Distribution: Widely distributed; plasma protein binding is low (~15%).

Metabolism: Minimal; primarily excreted unchanged.

Excretion: Excreted mainly unchanged by the kidneys.

Half Life: Approximately 12.5 hours.

Contraindications

  • History of angioedema related to previous ACE inhibitor therapy
  • Hereditary or idiopathic angioedema
  • Concurrent use with aliskiren in patients with diabetes or renal impairment

Precautions

  • Pregnancy (avoid during second and third trimester due to fetopathic effects), breastfeeding, renal artery stenosis, volume depletion, electrolyte imbalances (hyperkalemia)

Adverse Reactions - Common

  • Headache (Common)
  • Dizziness (Common)
  • Cough (Common)
  • Hypotension (Common)

Adverse Reactions - Serious

  • Angioedema (Rare)
  • Hypotension leading to syncope (Uncommon)
  • Hyperkalemia (Uncommon)
  • Acute kidney injury (Uncommon)

Drug-Drug Interactions

  • Diuretics (potassium-sparing, thiazide)
  • Other antihypertensives
  • Potassium supplements and potassium-sparing diuretics
  • Lithium
  • NSAIDs

Drug-Food Interactions

  • Excess potassium intake can increase the risk of hyperkalemia

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function (BUN, serum creatinine), and serum electrolytes regularly.

Diagnoses:

  • Risk for decreased cardiac output
  • Risk for electrolyte imbalance
  • Risk for renal impairment

Implementation: Administer as prescribed, monitor for signs of hypotension, angioedema, and cough, educate patient on non-pharmacologic measures to control blood pressure.

Evaluation: Assess for decrease in blood pressure to target levels, monitor for adverse effects, check renal function and electrolytes periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed, even if feeling well.
  • Rise slowly from sitting or lying position to prevent dizziness.
  • Notify healthcare provider if swelling of face, lips, or tongue occurs.
  • Avoid potassium supplements and salt substitutes containing potassium.
  • Report any signs of angioedema or persistent cough.

Special Considerations

Black Box Warnings:

  • Pregnancy: Use during second and third trimester can cause injury or death to the fetus.

Genetic Factors: Genetic variations in ACE genes may affect response.

Lab Test Interference: May increase serum creatinine and blood urea nitrogen (BUN).

Overdose Management

Signs/Symptoms: Severe hypotension, dizziness, hyperkalemia, renal impairment.

Treatment: Discontinue lisinopril, administer intravenous fluids for hypotension, monitor electrolytes and renal function, consider vasopressors if needed.

Storage and Handling

Storage: Store at room temperature, away from moisture, heat, and light.

Stability: Stable under normal conditions for at least 2 years.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.