Drug pharmacology, pharmacokinetics

Full Answer Section

Pregnancy Class

• D: Do not use; risk to fetus outweighs potential benefits

Cost Analysis

The cost of lisinopril can vary depending on the pharmacy and dosage. However, it is generally considered an affordable medication. Generic lisinopril is often more cost-effective than brand-name versions.

Patient Case Study

Patient: A 65-year-old male with a history of hypertension, type 2 diabetes, and coronary artery disease. He presents with complaints of fatigue, shortness of breath, and ankle swelling.

Diagnosis: Congestive heart failure

Treatment: Lisinopril 10 mg orally once daily, in addition to other medications for his conditions.

Peer-reviewed evidence-based studies:

• Lisinopril in Patients with Heart Failure: The Heart Failure Trial. The New England Journal of Medicine, 2001.
• Lisinopril and Survival in Patients with Heart Failure. The Lancet, 1999.

Patient Education

• Inform the patient about the importance of taking lisinopril as prescribed and avoiding missed doses.
• Educate the patient about the potential side effects of the medication, especially hypotension and angioedema.
• Advise the patient to monitor their blood pressure regularly and to report any significant changes to their healthcare provider.
• Instruct the patient to avoid salt substitutes, as they can increase potassium levels.
• Inform the patient about the importance of maintaining a healthy diet and regular exercise.
• Discuss the risk of teratogenic effects if the patient becomes pregnant while taking lisinopril.

Role of the Nurse Practitioner

As a nurse practitioner, your role in prescribing lisinopril to this patient would include:

• Conducting a thorough assessment to determine the appropriate dosage and monitor for side effects.
• Educating the patient about the medication and its potential risks and benefits.
• Monitoring the patient's response to the medication and adjusting the dosage as needed.
• Referring the patient to a cardiologist for further evaluation and management if necessary.

Monitoring and Follow-up

• Monitor the patient's blood pressure, serum potassium, and renal function regularly.
• Assess for signs and symptoms of hypotension, angioedema, and hyperkalemia.
• Schedule follow-up appointments to evaluate the patient's response to the medication and make any necessary adjustments.

By providing comprehensive care and education, nurse practitioners can help patients with congestive heart failure manage their condition effectively and improve their quality of life.

Sample Solution

Drug Selection: Lisinopril

Brand Name: Prinivil, Zestril Generic Name: Lisinopril Class: Angiotensin-converting enzyme (ACE) inhibitor

Dosing

• Initial dose: 10-20 mg orally once daily
• Maintenance dose: 10-40 mg orally once daily, may be increased gradually as needed
• Maximum dose: 60 mg orally once daily

Indications for Use

• Hypertension
• Congestive heart failure
• Left ventricular dysfunction after a myocardial infarction
• To improve survival in patients with heart failure and left ventricular dysfunction

Side Effects

• Hypotension
• Dizziness
• Headache
• Fatigue
• Cough
• Angioedema
• Hyperkalemia
• Renal impairment

Contraindications

• Pregnancy
• History of angioedema associated with ACE inhibitors
• Bilateral renal artery stenosis