Lisinopril Nursing Considerations

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used primarily to treat hypertension, heart failure, and improve survival after heart attacks. As one of the most prescribed medications in its class, understanding its nursing considerations is crucial for healthcare providers.

Generic name: Lisinopril

Brand names: Prinivil, Zestril, Qbrelis

Pharmacologic class: Angiotensin-Converting Enzyme (ACE) Inhibitor

Therapeutic class: Antihypertensive, Cardiovascular agent

Mechanism of action: Lisinopril prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This results in decreased blood pressure through vasodilation and reduced aldosterone secretion, decreasing sodium and water retention.

Indications for use: Treatment of hypertension, congestive heart failure, acute myocardial infarction, and diabetic nephropathy. It is also used to reduce mortality after heart attacks and prevent the progression of renal disease in diabetic patients.

Precautions and contraindications: History of angioedema related to previous ACE inhibitor therapy, pregnancy (Category D), bilateral renal artery stenosis, hyperkalemia, and patients with hereditary/idiopathic angioedema.

Drug Interactions

• NSAIDs may decrease the antihypertensive effects.
• Potassium supplements or potassium-sparing diuretics increase the risk of hyperkalemia.
• Lithium levels may be increased when taken with lisinopril
• Combined use with ARBs or aliskirens increasesthe risk of hypotension, hyperkalemia, and renal impairment

Adverse Effects

• Persistent dry cough
• Dizziness, headache, fatigue
• Hyperkalemia
• Hypotension, especially after the initial dose
• Acute kidney injury
• Angioedema (severe but rare)
• Taste alterations
• GI disturbances: diarrhea, nausea, vomiting

Administration Considerations

Available preparations: Tablets (2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg), oral solution (1 mg/mL)

Typical dosages:

• Hypertension: Initial 10 mg once daily, maintenance 20-40 mg once daily
• Heart failure: Initial 2.5-5 mg once daily, target 20-40 mg once daily
• Post-MI: Initial 5 mg within 24 hours, followed by 5 mg after 24 hours, then 10 mg once daily

Onset: 1 hour
Peak effect: 6 hours
Duration: 24 hours

Nursing Considerations for Lisinopril

Related Nursing Diagnoses

• Risk for decreased cardiac output
• Risk for acute kidney injury
• Deficient knowledge regarding medication regime
• Risk for falls related to hypotension
• Risk for electrolyte imbalance

Nursing Assessment

1. Assess baseline vital signs, especially blood pressure, before administration. Monitor for hypotension, particularly after the initial dose or dose increases.
2. Evaluate renal function through BUN, creatinine, and GFR before starting therapy and periodically during treatment.
3. Monitor serum potassium levels regularly, especially in patients taking potassium supplements or potassium-sparing diuretics.
4. Assess for the presence of dry cough, which is a common side effect of ACE inhibitors.
5. Monitor for signs of angioedema: swelling of face, lips, tongue, or throat.

Nursing Interventions

1. Administer the first dose at bedtime to minimize the risk of syncope from initial hypotension.
2. Monitor blood pressure frequently during initial therapy and with dose adjustments.
3. Assess for signs of hyperkalemia: weakness, fatigue, irregular heartbeat.
4. Document the presence and characteristics of any cough that develops.
5. Keep emergency equipment readily available due to the risk of angioedema.

Patient Teaching Associated with Lisinopril

1. Take medication at the same time each day. If a dose is missed, take it as soon as remembered unless it’s almost time for the next dose.
2. Rise slowly from sitting or lying positions to prevent orthostatic hypotension.
3. Report any persistent dry cough, a common side effect that may require medication change.
4. Avoid potassium supplements or salt substitutes containing potassium unless prescribed by a healthcare provider.
5. Women who become pregnant should immediately contact their healthcare provider, as lisinopril can cause fetal harm.
6. Monitor blood pressure at home if prescribed and keep a log of readings.
7. Maintain adequate hydration but avoid excessive alcohol use.
8. Report signs of angioedema immediately: swelling of face, lips, tongue, or throat, difficulty breathing or swallowing.
9. Continue taking medication even when feeling well, as hypertension is typically asymptomatic.

Note: This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult with a pharmacist for complete information.

References

1. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 
2. Goa KL, Haria M, Wilde MI. Lisinopril. A review of its pharmacology and use in the management of the complications of diabetes mellitus. Drugs. 1997 Jun;53(6):1081-105. doi: 10.2165/00003495-199753060-00010. PMID: 9179532.
3. Olvera Lopez E, Parmar M, Pendela VS, Terrell JM. Lisinopril. 2024 Oct 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29489196.
4. Raia JJ Jr, Barone JA, Byerly WG, Lacy CR. Angiotensin-converting enzyme inhibitors: a comparative review. DICP. 1990 May;24(5):506-25. doi: 10.1177/106002809002400512. PMID: 2188439.
5. Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.