Mindanao State University – Iligan Institute of Technology Student: Lelis, Ellijoy L.

Section:260

PHARMACOLOGY

DRUG STUDY

Brand Name: Lisinopril Generic Name: Zestril Drug Classification: ACE inhibitor, Antihypertensive

Dosage, Route & Frequency Drug-Drug & Drug- Side Effects Adverse Reactions (By
Drug Action Indications Contraindications
Recommended Prescribed Food Interactions (By System) System)
Hypertension PO (Adults): 10 mg Absorption: 25% DRUG: Diuretics (e.g., Alone or with Contraindicated in: CNS: dizziness, Excessive hypotension
once daily, can be increase up to 20– absorbed furosemide, HCTZ) may other agents in Hypersensitivity; fatigue, headache, (“first-dose syncope”) may
40 mg/day (initiate therapy at 5 following oral increase hypotensive the History of weakness. occur in pts with HF,
mg/day in patients receiving administration effects. May increase management of angioedema with Resp:cough. CV: severe salt/volume
diuretics). (much inter- concentration, risk of hypertension. previous use of ACE hypotension, chest depletion. Angioedema
individual toxicity of lithium. Management of inhibitors; pain. GI: abdominal (swelling of face and lips),
PO (Children ≥ 6 yr): 0.07 mg/kg once variability). NSAIDs (e.g., ibuprofen, heart failure. Concurrent use pain, diarrhea, hyperkalemia occur rarely.
daily (up to 5 mg/day), may be Distribution: ketorolac, naproxen) Reduction of risk with aliskiren in nausea, vomiting. GU: Agranulocytosis,
titrated every 1– 2 wk up to 0.6 Crosses the may decrease effects. of death or patients with erectile dysfunction, neutropenia may be noted
mg/kg/day (or 40 mg/day). placenta; may Potassium-sparing development of diabetes or impaired renal in pts with collagen
Renal Impairment PO (Adults): CCr enter breast milk. diuretics (e.g., heart failure moderateto-severe function.Derm:rashes. vascular disease
10– 30 mL/min—Initiate therapy at 5 Metabolism and spironolactone, after myocardial renal impairment F and E: (scleroderma, systemic
mg daily; may be slowly titrated up to Excretion: 100% triamterene), potassium infarction. (CCr<60 mL/min); hyperkalemia.Misc: lupus erythematosus).
40 mg/day. CCr<10 mL/min—Initiate eliminated by the supplements may cause OB: Can cause ANGIOEDEMA. Nephrotic syndrome may
therapy at 2.5 mg once daily; may be kidneys. Half-life: hyperkalemia. May injury or death of be noted in pts with
slowly titrated up to 40 mg/day. 12 hr (increase in increase hypoglycemic fetus – if pregnancy history of renal disease..
renal effect of oral occurs, discontinue
Renal Impairment (Children ≥ 6 yr): impairment). hypoglycemic agents immediately;
CCr < 30 mL/min—Contraindicated. (e.g., glyBURIDE, Lactation:
Heart Failure PO (Adults): 5 mg once Route: PO Onset: metFORMIN). HERBAL: Discontinue drug or
daily, may be titrated every 2 wk up 1 hr Peak: 6 hr Ephedra, ginseng, use formula
to 40 mg/day; initiate therapy at 2.5 Duration: 24 hr licorice, yohimbe may
mg once daily in patients with worsen hypertension.
hyponatremia (serum sodium <130 Black cohosh, periwinkle
mEq/L). may increase
antihypertensive effect.
Renal Impairment (Adults): CCr ≤ 30 FOOD: None known. LAB
mL/min—Initiate therapy at 2.5 mg VALUES: May increase
once daily. serum BUN, alkaline
Acute Myocardial Infarction PO phosphatase, bilirubin,
(Adults): 5 mg once daily for 2 days, creatinine, potassium,
then 10 mg daily. ALT, AST. May decrease
serum sodium. May
Renal Impairment PO (Adults): cause positive ANA titer.
Initiate with caution in patients with
serum creatinine >2 m g/dL.

Responsibilities in the Nursing Process (ADPIE)
Assessment: Obtain BMP (esp. serum BUN, creatinine, sodium, potassium; CrCl, GFR. Obtain B/P,
apical pulse immediately before each dose in addition to regular monitoring (be alert to
fluctuations). Question history of aortic stenosis, cardiac disease, cardiomyopathy, renal
impairment or stenosis. Intervention/evaluation Monitor B/P, renal function tests, WBC, serum
potassium. Assess for edema. Auscultate lungs for rales. Monitor I&O; weigh daily. Monitor daily
pattern of bowel activity, stool consistency. Assist with ambulation if dizziness occurs. If excessive
reduction in B/P occurs, place pt in supine position, feet slightly elevated.
Responsibilities in the Nursing Process (ADPIE)
Implementation : Do not confuse Zestril with Zegerid, Zetia, or Zyprexa. Correct volume
depletion, if possible, before initiation of therapy. Precipitous drop in BP during first 1– 3 hr
following first dose may require volume expansion with normal saline. Discontinuing diuretic
therapy or cautiously increasing salt intake 2– 3 days prior to initiation may decrease risk.
Monitor closely for at least 1 hr after BP has stabilized. Resume diuretics if BP is not
controlled. PO: For patients with difficulty swallowing tablets, pharmacist can compound an
oral suspension; stable at room temperature for 4 wk. Shake suspension before each use.

Potential Nursing Diagnoses: Decreased cardiac output (Indications) (Side Effects) Noncompliance Evaluation/Desired Outcomes: Decrease in BP without appearance of excessive side effects.
(Patient/Family Teaching) Improvement in survival and reduction of symptoms in heart failure. Reduction of risk of
death or development of heart failure after myocardial infarction.
Patient/ family teaching: To reduce hypotensive effect, go from lying to standing slowly. Limit
alcohol intake. Report vomiting, diarrhea, diaphoresis, swelling of face/lips/tongue, difficulty in
breathing, persistent cough. Limit salt intake. Maintain adequate hydration. Report decreased
urinary output, dark-colored urine, swelling of the hands and feet. Immediately report allergic
reactions, esp. life-threatening swelling of the face or tongue.

https://www.webmd.com/drugs/2/drug-849/valsartan-oral/details
http://www.robholland.com/Nursing/Drug_Guide/data/monographs/monoframe.html?vfile=V006.html