Nurses Compass
Drug Guide
Quinapril Hydrochloride
Classification
Therapeutic: Antihypertensive
Pharmacological: ACE Inhibitor (Angiotensin-Converting Enzyme Inhibitor)
FDA Approved Indications
- Hypertension
- Heart failure (as adjunct therapy)
Mechanism of Action
Quinapril inhibits angiotensin-converting enzyme (ACE), reducing the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This results in vasodilation, decreased blood pressure, and decreased workload on the heart.
Dosage and Administration
Adult: Typically 10-40 mg once daily, titrated based on response.
Pediatric: Not generally recommended for children.
Geriatric: Start at lower doses due to increased sensitivity and risk of adverse effects.
Renal Impairment: Dosing adjustment is necessary, start with lower doses.
Hepatic Impairment: Use with caution; no specific dose adjustment established.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Wide tissue distribution, crosses placenta.
Metabolism: Partially metabolized in the liver to active metabolite quinaprilat.
Excretion: Primarily excreted by the kidneys, both parent and active metabolite.
Half Life: Approximately 2 hours for quinapril; active metabolite has a half-life of approximately 6 hours.
Contraindications
- History of angioedema related to previous ACE inhibitor use
- Bilateral renal artery stenosis
- Hypersensitivity to quinapril or other ACE inhibitors
Precautions
- Pregnancy (discontinue as soon as pregnancy is detected)
- Renal impairment
- Hypotension
- Hyperkalemia
Adverse Reactions - Common
- Cough (Common)
- Dizziness (Common)
- Headache (Common)
- Fatigue (Common)
Adverse Reactions - Serious
- Angioedema (Rare, but serious)
- Hyperkalemia (Uncommon)
- Hypotension (Uncommon)
- Renal function decline (Uncommon)
Drug-Drug Interactions
- Diuretics (potassium-sparing or thiazide)
- Potassium supplements or potassium-containing salt substitutes
- Other antihypertensives (additive hypotensive effect)
- NSAIDs (may reduce antihypertensive effect and impair renal function)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function (BUN, serum creatinine), and electrolytes regularly.
Diagnoses:
- Ineffective tissue perfusion related to decreased cardiac output
- Risk for electrolyte imbalance
Implementation: Administer medication consistently at the same time daily, monitor for adverse effects, advise patient to rise slowly from sitting or lying position.
Evaluation: Assess blood pressure response, renal function, and electrolyte levels to evaluate effectiveness and safety.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Do not increase or decrease dose without consulting healthcare provider.
- Report signs of angioedema (swelling of face, lips, tongue, or throat), severe dizziness, or hyperkalemia.
- Avoid potassium supplements and potassium-rich foods unless directed.
- Notify provider if pregnant or planning to become pregnant.
Special Considerations
Black Box Warnings:
- Fetal toxicity when used during pregnancy, particularly in the second and third trimesters.
Genetic Factors: N/A
Lab Test Interference: May cause increases in serum potassium and BUN/creatinine levels.
Overdose Management
Signs/Symptoms: Severe hypotension, hyperkalemia, renal failure.
Treatment: Discontinue medication, supportive care, and symptomatic treatment. Consider administration of vasopressors for hypotension. Dialysis may be necessary in renal failure.
Storage and Handling
Storage: Store at room temperature away from moisture and heat.
Stability: Stable at room temperature, protect from moisture.