Lisinopril

Lisinopril

Drug monograph · NCLEX study reference
Trade names	Prinivil, Zestril
Therapeutic class	Antihypertensive, heart failure agent
Pharmacologic class	Angiotensin-converting enzyme (ACE) inhibitor
Onset / peak / duration	Onset about 1 hour; peak 6 to 8 hours; duration about 24 hours.
Half-life / level	Half-life about 12 hours; no routine level.
Routes	PO (oral)
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	No specific antidote; supportive care, and for angioedema discontinue and treat airway.
Pregnancy / lactation	Contraindicated, especially second and third trimesters.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Lisinopril (brand names Prinivil, Zestril) — Antihypertensive, heart failure agent; Angiotensin-converting enzyme (ACE) inhibitor.

Identification

• Therapeutic class: Antihypertensive, heart failure agent.
• Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor.

Pharmacology

• Mechanism of action: Blocks conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone, which lowers blood pressure and cardiac workload.
• Onset / peak / duration: Onset about 1 hour; peak 6 to 8 hours; duration about 24 hours.
• Half-life / therapeutic level: Half-life about 12 hours; no routine level.

Clinical use

• Indications: Hypertension, heart failure, post-myocardial-infarction, diabetic nephropathy.
• Usual dose, route, frequency: 10 to 40 mg PO once daily.
• Maximum dose / adjustments: Max 80 mg/day; reduce starting dose in renal impairment and in volume-depleted or elderly patients.

Safety

• Contraindications: History of angioedema, bilateral renal artery stenosis, pregnancy, concurrent aliskiren in diabetes.
• Black box warning: Fetal toxicity; discontinue as soon as pregnancy is detected.
• Interactions: Potassium supplements and potassium-sparing diuretics (hyperkalemia), NSAIDs (reduced effect, renal risk), lithium (toxicity), salt substitutes containing potassium (food); diuretics increase first-dose hypotension.
• Pregnancy / lactation: Contraindicated, especially second and third trimesters.
• High-alert: No.

Adverse effects

• Common side effects: Dry nonproductive cough, dizziness, hyperkalemia, fatigue.
• Serious effects to report: Angioedema (facial/throat swelling), hyperkalemia, acute kidney injury, first-dose hypotension.
• Antidote / reversal: No specific antidote; supportive care, and for angioedema discontinue and treat airway.

Nursing process

• Assessment before administration: Blood pressure, baseline renal function and potassium, pregnancy status, history of angioedema.
• Interventions during therapy: Monitor for first-dose hypotension; assess for cough and swelling.
• Monitor: Blood pressure, serum potassium, BUN and creatinine.
• Evaluation / expected outcome: Blood pressure at goal; improved heart failure symptoms.

Patient teaching

• Patient teaching: Persistent dry cough is common and reversible; rise slowly to avoid dizziness.
• Notify provider if: Swelling of face, lips, or tongue; difficulty breathing; persistent cough; signs of high potassium.
• Administration tips: Same time daily; avoid potassium-based salt substitutes; do not stop abruptly.