February 1, 2023

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Today we’re going to go through lisinopril the brand names are zestrill prinnaville and cubrellis the therapeutic category is that this is an anti-hypertensive drug more specifically it’s an ace inhibitor or an angiotensin converting enzyme inhibitor indications are that it’s used in hypertension for blood pressure management it’s also used in heart failure with

Reduced ejection fraction it reduces the signs and symptoms of systolic heart failure it’s typically used as adjunctive therapy the third indication is an st elevation myocardial infarction or stemi in hemodynamically stable patients it’s used within 24 hours in the treatment of acute mi some of the off-label indications for lycinopril are in non-st elevation

Myocardial infarctions or enzemi in post-transplant erythrocytosis in renal patients in chronic kidney disease or ckd and in stable coronary artery disease the typical dosage form is in tablets but it also comes in a solution the tablet comes in several strengths it comes in a 2.5 milligram a 5 a 10 a 20 a 30 and a 40. the solution comes in a one milligram per

Milliliter concentration dosing for hypertension it starts at five to ten milligrams once daily with patient evaluation every four to six weeks the dose is doubled until the recommended 40 milligrams per day is reached or the patient tolerance whichever comes first dosing for acute coronary syndromes and stemi you start at 2.5 to 5 milligrams once daily started

Within 24 hours of the event and you titrate up to 10 milligrams per day with a max at 40 milligrams per day and stemi which was off label is between 2.5 to 10 milligrams started once daily titrating up to 40 milligrams a day other off-label dosings such as for transplant patients is 2.5 milligrams to 10 milligrams once daily so it’s pretty similar to end stemi or

Stemi dosing the cinepril is also used in hypertensive pediatric patients with limited data the dose of 0.07 milligrams per kilogram per day dosed once daily with a max of 5 milligrams per day is initiated and the goal of 0.6 milligrams per kilogram per day or 40 milligrams per day as the max is what’s generally accepted mechanism of action and pharmacology the

Cinepril works through the competitive inhibition of the angiotensin-converting enzyme which is responsible for converting angiotensin-1 to angiotensin-2 which is a strong vasoconstrictor next a reduction of angiotensin ii increases plasma renin activity which decreases secretions of aldosterone then a decrease of angiotensin ii also decreases adrenergic outflow

From the central nervous system while vasoactive calicrines are also decreased so this medication is not metabolized the excretion occurs in the urine with the drug being unchanged the onset of action is typically within 1 hour with a peak at 6 hours the median peak is somewhere between 5 and 7 hours the medication has a 24 hour duration and the half-life is at

12 hours there’s also special considerations in renally impaired patients side effects so the major ones are cardiovascular hypotension and dizziness the minor ones are syncope chest pain headache a change in the sense of smell skin rash and vision issues there’s a warning for cough angioedema and cholestatic giandis drug interactions lisinopril may increase

Allopurinol hypersensitivities there’s also a diminished effect when used with amphetamines arbs generally enhance adverse toxic effects of aces you also want to watch out for sources of potassium such as potassium containing salt substitutes antipsychotics mood stabilizers and barbiturates may increase the hypotensive effects of lacinopril do not use if pregnant

Due to fetal toxicity if the patient is or is believed to be pregnant discontinue immediately this medication will cause injury and can lead to death of the fetus monitoring parameters potassium renal function within one to two weeks after initiation and pregnancy and females also monitor liver enzymes and serum bilirubin patient counseling the main thing is

To watch out for cough headaches are also common another concern is to watch for dark urine patients sometimes also experience fatigue and an abnormal heartbeat

Transcribed from video
#4: lisinopril (Prinivil, Zestril) | Treating Hypertension and STEMI | Drug Cards Daily By Drug Cards Daily