lisinopril
Prinivil, Zestril
Nursing Considerations
• Use lisinopril cautiously in patients with
fluid volume deficit, heart failure, impaired
renal function, or sodium depletion.
• To prepare pediatric suspension, add
10 ml purified water to a polyethylene
terephthalate (PET) bottle containing ten
20-mg tablets and shake for at least
1 minute. Add 30 ml of Bicitra diluent and
160 ml of Ora-Sweet SF to concentrate in
PET bottle and shake gently for several
seconds. Refrigerate up to 4 weeks. Shake
suspension before each use.
•Monitor blood pressure often, especially
early in treatment. If excessive hypotension
develops, expect to withhold drug
for several days.
WARNING If angioedema affects face, glottis,
larynx, limbs, lips, mucous mem-
branes, or tongue, notify prescriber immediately
and expect to stop lisinopril and
start appropriate therapy at once. If airway
obstruction threatens, promptly give 0.3 to
0.5 ml of epinephrine 1:1,000 solution
subcutaneously, as prescribed.
•Monitor patient for anaphylaxis, especially
patient being dialyzed with high-flux
membranes and treated with an ACE
inhibitor such as lisinopril. If anaphylaxis
occurs, stop dialysis immediately and treat
aggressively (antihistamines are ineffective
in this situation), as ordered. Anaphylaxis
has also occurred with some patients
undergoing low-density lipoprotein
apheresis with dextran sulfate absorption.
• Notify prescriber if patient has persistent,
nonproductive cough, a common adverse
effect of ACE inhibitors such as lisinopril.
•Monitor for dehydration, which can lead
to hypotension. Be aware that diarrhea
and vomiting can cause dehydration.
•Monitor patient for hepatic dysfunction
because lisinopril, an ACE inhibitor, may
rarely cause a syndrome that starts with
cholestatic jaundice or hepatitis and progresses
to fulminant hepatic necrosis. If
patient develops jaundice or a marked elevation
in liver enzyme levels, withhold
drug and notify prescriber.
• If patient takes insulin or an oral antidiabetic,
monitor blood glucose level closely
because risk of hypoglycemia increases,
especially during first month of therapy.
PATIENT TEACHING
• Explain that lisinopril helps to control but
doesn’t cure hypertension and that patient
may need lifelong therapy.
• Advise patient to take lisinopril at the
same time every day.
• Emphasize need to take drug as ordered,
even if patient feels well; caution her not
to stop drug without consulting prescriber.
• Instruct patient to report dizziness, especially
during first few days of therapy.
• Inform patient that persistent, nonproductive
cough may develop during lisinopril
therapy. Urge her to notify prescriber
immediately if cough becomes difficult to
tolerate.
• Advise patient to drink adequate fluid and
avoid excessive sweating, which can lead to
dehydration and hypotension.Make sure
she understands that diarrhea and vomiting
also can cause hypotension.
• Caution patient not to use salt substitutes
that contain potassium.
• Instruct patient to report signs of infection,
such as fever and sore throat, which
may indicate neutropenia.
• Advise patient to change position slowly to
minimize orthostatic hypotension.
• If patient has diabetes and takes insulin or
an oral antidiabetic, urge her to monitor
her blood glucose level closely and watch
for symptoms of hypoglycemia.
• Caution female patient to notify prescriber
immediately if she is or could be pregnant.
