Prinivil Lisinopril

NURS 2516 Clinical Medications Worksheets (You will need to make additional copies of these forms) Generic Name

Trade Name Prinivil

Classification ACE Inhibitors

Lisinopril

Dose: 10 mg

Route Time/frequency

Dosage range: 10 mg once daily, can be increased up to 20-40 mg/day (initiate therapy at 5 mg/day in patients receiving diuretics).

PO

Peak

Onset

Duration

6 hr

1 hr

24 hours

Mechanism of action and indications (Why med ordered) Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation. Indicated for the treatment of hypertention. My patient is receiving this med for Hypertension.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Additive hypotension with other antihypertensive agents (Coreg for ex.)

Daily

For IV meds, compatibility with IV drips and /or solutions N/A Nursing Implications (what to focus on) Contraindications/warnings/interactions pt’s w/ Hypersensitivity and history of angioedema with previous use of ACE inhibitors. Use cautiously in pt’s w/ Renal impairment, hypovolemia, hyponatremia, geriatric patients, concurrent diuretic therapy (initial dosage reduction recommended). Use extreme caution in pt’s w/ a family history of angioedema.

Common side effects dizziness, cough,hypotension, n/v/d, rashes, hyperkalemia, and angioedema

Lab value alterations caused by medicine Monitor BUN, creatinine, and electrolyte levels periodically. Serum potassium may be increased and BUN and creatinine transiently increased, whereas sodium levels may be decreased. If elevated BUN or serum creatinine concentrations occur, dosage reduction or withdrawal may be required. Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause slight decrease in hemoglobin and hematocrit and agranulocytosis. May cause elevated AST, ALT, alkaline phosphatase, and serum bilirubin.

Be sure to teach the patient the following about this medication Instruct patient to take exactly as directed at the same time each day, even if feeling well. Missed doses should be taken as soon as possible but not if almost time for next dose. Do not double doses. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional. Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. Caution patient to change positions slowly to minimize hypotension, particularly after initial dose. Patients should also be advised that exercising in hot weather may increase hypotensive effects. Advise patient to consult health care professional before taking any OTC medications, especially cold remedies. May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known. Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues. Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management).

Nursing Process- Assessment (Pre-administration assessment) Take blood pressure

Assessment Why would you hold or not give this med? If bp is too low contact physician. These should not be stopped abruptly

Evaluation Check after giving Decrease in blood pressure without appearance of side effects and improvement in survival and reduction of symptoms in heart failure