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