Prinivil Lisinopril

NURS 1566 Clinical Form 3: Clinical Medications Worksheets (You will need to make additional copies of these forms) Generic Name lisinopril Peak 6 hrs

Trade Name Classification Dose Route Time/frequency Prinivil, Zestril antihypertensives 20 mg PO Q am Onset Duration Normal dosage range 1 hr 24 hrs 10 mg once daily, can be increased up to 20-40 mg/day

Why is your patient getting this medication HTN

For IV meds, compatibility with IV drips and/or solutions N/A Mechanism of action and indications Nursing Implications (what to focus on) (Why med ordered) Contraindications/warnings/interactions ACE inhibitors block the conversion of angiotensin I Hypersensitivity, Cross-sensitivity among ACE inhibitors to the vasoconstrictor angiotensin II. ACE also may occur, angioedema (hereditary or idiopathic), renal inactivates the vasodilator bradykinin and other impairment, hepatic impairment, hypovolemia, vasodilatory prostaglandins. ACE inhibitors also hyponatremia, elderly patients, concurrent diuretic therapy increase plasma renin levels and reduce aldosterone (initial dose reduction recommended for most agents), levels. Net result is systemic vasodilation. cerebrovascular or cardiac insufficiency, surgery/anesthesia (hypotension may be exaggerated), family history of angioedema. Common side effects Cough, hypotension, taste disturbances, proteinuria, AGRANULOCYTOSIS, ANGIOEDEMA

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Additive hypotension may occur when used concurrently with other antihypertensives (Norvasc, Coreg) and acute ingestion of alcohol.

Lab value alterations caused by medicine Monitor BUN, creatinine, and electrolyte levels periodically. Serum potassium may be ↑ and BUN and creatinine transiently ↑, whereas sodium levels may be ↓. If ↑ BUN or serum creatinine concentrations occur, dose reduction or withdrawal may be required. May rarely cause slight ↓ in hemoglobin and hematocrit. May cause ↑ AST, ALT, alkaline phosphatase, serum bilirubin, uric acid, and glucose. May cause positive ANA titer. Be sure to teach the patient the following about this medication Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses 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 or foods containing high levels of potassium or sodium unless directed by healthcare 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. Advise patient to inform health care professional of medication regimen prior to treatment or surgery. 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; difficulty swallowing or breathing occur ; or if taste impairment or skin rash persists. 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. Emphasize the importance of follow-up examinations to monitor progress. Encourage patient to comply with additional interventions for hypertension (weight reduction, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension. Instruct patient and family on correct technique for monitoring blood pressure. Advise them to check blood pressure at least weekly and to report significant changes to

Nursing Process- Assessment (Pre-administration assessment) Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.

Assessment Why would you hold or not give this med? Hypotension. Intolerable side effects.

Evaluation Check after giving Decrease in blood pressure without appearance of side effects.