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Lisinopril (Prinivil, Zestril)

ACE inhibitor (angiotensin-converting enzyme inhibitor)

Mechanism of action

Blocks the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone release. Net effect: lower blood pressure, less sodium and water retention, reduced cardiac afterload, and renal protection in diabetic nephropathy. Used for hypertension, heart failure, and post-MI.

Adverse effects

Life-threatening / NCLEX-tested

  • Angioedema — swelling of lips, tongue, face, or airway; potentially life-threatening; higher incidence in Black patients
  • First-dose hypotension, especially in volume-depleted or diuretic-treated patients
  • Hyperkalemia (K+ > 5.0 mEq/L) — angiotensin II normally drives aldosterone
  • Acute kidney injury, particularly with bilateral renal artery stenosis
  • Teratogenic — contraindicated in pregnancy (any trimester)

Side effects

Common — what to teach

  • Persistent dry, hacking cough (~10–20% of patients; cause for switching to an ARB)
  • Dizziness, lightheadedness
  • Headache
  • Fatigue
  • Loss of taste (dysgeusia)
  • Mild rash

Food & drug interactions

Potassium-sparing diuretics (spironolactone, eplerenone), potassium supplements, and salt substitutes (KCl-based) compound hyperkalemia risk. NSAIDs blunt the antihypertensive effect and worsen renal function. Lithium clearance falls — risk of lithium toxicity. Combining with an ARB or aliskiren is contraindicated (the "dual RAAS blockade" trial signal of harm). Alcohol amplifies hypotension.

Nursing implications

Assessment, monitoring, patient teaching

  • Check BP and pulse before every dose; warn patients about first-dose hypotension and rise slowly from sitting/lying
  • Monitor serum K+, BUN, and creatinine at baseline, 1–2 weeks after start or dose change, then periodically
  • Teach patients to report swelling of the face, lips, or tongue immediately and stop the drug — this is angioedema
  • Counsel about the dry cough — it is not dangerous but is the most common reason patients ask to switch
  • Avoid potassium-rich salt substitutes; review supplement and OTC use (NSAIDs)
  • Pregnancy test before starting in women of childbearing age; counsel on contraception

When to hold / contraindications

  • SBP < 90–100 mmHg or symptomatic hypotension
  • Serum K+ > 5.0 mEq/L
  • Rising creatinine > 30% from baseline (signal of renal compromise)
  • Any signs of angioedema — discontinue permanently, do not rechallenge
  • Confirmed or suspected pregnancy

Memory anchor

ACE inhibitors end in "-pril" and bring the "3 Cs": Cough, hyperKalemia, Creatinine bump (and Cancel in pregnancy). Angioedema = stop and never restart.

Reminder: Drug cards are study aids, not clinical guidance. Always cross-check doses, holds, and contraindications with your facility's formulary and your clinical instructors before patient care.

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