Lisinopril Therapeutic class - Drug for HF and HTN
Lisinopril Pharmacologic class - ACE inhibitor
Lisinopril Actions and Uses - - One of the most frequently prescribed drugs
- Inhibits ACE and decreases aldosterone production
- Decreases BP, increases CO
- 2-3 weeks of therapy required for max effect; several months for cardiac function to
return to normal
- Improves survival for patients when given within 24 hours of MI
- Prinzide & Zestoretic: fixed dose of lisinopril and hydrochlorothiazide, marketed for
HTN
- Used off-label to treat migraines
Lisinopril Administration - - Check BP before administering to determine if effects are
lasting 24 h & if BP is within parameters
- Safety and efficacy established for ages 6 and up
- Older adults and those w/ CKD should receive lower dose to prevent toxicity
Lisinopril Pregnancy category - C (1st trimester), D (2nd and 3rd trimesters)
Lisinopril Onset - 1 hour
Lisinopril Duration - 24 h
Lisinopril Adverse Effects - - Most common: cough, HA, dizziness, orthostatic
hypotension, rash
- Hyperkalemia may occur, monitor electrolyte levels
- Other effects: taste disturbances, chest pain, N/V/D
Lisinopril Contraindications - - Patients w/ hyperkalemia
- Patients who have previous experience of angioedema w/ ACE inhibitor therapy
- Pregnant patients
Lisinopril Black box - Fetal injury and death may occur when taken during pregnancy.
When pregnancy is detected, D/C use as soon as possible
Lisinopril Drug to drug interactions - NSAIDs may cause decreased antihypertensive
activity; combined therapy w/ diuretics & other antihypertensives should be monitored;
hyperkalemia may result when taken w/ potassium-sparing diuretics; use w/ aliskiren
(Tekturna) can increase risk of hypotension & CKD; Valsartan w/ sacubitril may
increase risk for angioedema
,Lisinopril Lab test interactions - May increase BUN, serum bilirubin, serum AST, serum
ALT
Lisinopril Herbal/food interactions - Avoid excessive intake of K+ and K+ based salt
substitutes
Lisinopril Treatment of overdose - causes hypotension; treat w/ fluids or vasopressor
Metoprolol Pharmacologic class - Beta1-adrenergic blocker
Metoprolol Therapeutic class - Drug for HF and HTN
Metoprolol Actions and Uses - · Tablet, SR tablet and IV forms
· Regular release is not approved for treating HF
· Higher doses may effect beta2 receptors in bronchial smooth muscles
· Reduces sympathetic stimulation of the heart, decreases cardiac workload
· Slows progression of HF and reduces long-term consequences of disease
· When used for HF, usually combined w/ ACE inhibitors or ARBs
· Approved for angina, HTN, and reducing cardiac complications after MI
Metoprolol Administration - · IV admin: monitor ECG, BP & HR frequently
· Hold if HR is <60 BPM or if patient is hypotensive
· Do not crush or chew SR tablets
· Safety and efficacy not established for under 6 years old
· Reduce dose for older patients (dizziness & fall risk)
Metoprolol Pregnancy category - C
Metoprolol Onset - 10-15 min
Metoprolol Duration - 6 h; 24 h (SR)
Metoprolol Adverse Effects - · Generally minor; slowing of HR & hypotension
· Abnormal sexual function, drowsiness, fatigue, insomnia
Metoprolol Contraindications - · Patients w/ cardiogenic shock, sinus bradycardia, heart
block greater than first degree, hypotension and overt cardiac failure
· Use caution in patients w/ asthma and hx of bronchospasm because the drug may
affect beta2 receptors at high doses
Metoprolol Black box - Abrupt withdrawal may exacerbate angina or cause MI. Taper
dose over 1-2 weeks, reinstitute if angina symptoms develop during this period.
Metoprolol Drug to drug interactions - Use w/ digoxin may result in bradycardia; use w/
antihypertensives may result in additive hypotension; may enhance hypoglycemic
, effects of insulin and oral antidiabetics; use w/ verapamil increases risk of heart block
and bradycardia
Metoprolol Lab test interactions - May increase uric acid, lipids, K+, bilirubin, alkaline
phosphate, creatinine and ANA
Metoprolol Herbal/food interactions - Hawthorn may increase actions of beta-adrenergic
blockers
Metoprolol Treatment of overdose - Atropine or isoproterenol can reverse bradycardia;
vasopressors to reverse hypotension
Digoxin Therapeutic class - Drug for HF
Digoxin Pharmacologic class - Cardiac glycoside
Digoxin Actions and Uses - · Increases contractility or strength of myocardial
contraction; inhibits Na+K+ATPase; sodium accumulates, calcium ions are released
from storage producing a more forceful contraction of myocardial fibers
· Directly increases CO, alleviating symptoms of HF & improving exercise tolerance
· Improved CO increases urine production and reduces blood volume which relieves
distresses symptoms of pulmonary congestion and peripheral edema
· Has the ability to suppress SA node and slow electrical conduction through AV node;
sometimes uses to treat dysrhythmias
Digoxin Administration - · Before admin: take apical pulse for full minute (note rate,
rhythm & quality); withhold if HR is below parameter
· Before admin check recent serum digoxin levels, hold if below parameters (usually 1.8
ng/mL)
· Use caution w/ geriatric and peds, may have inadequate renal and hepatic metabolic
enzymes
Digoxin Pregnancy category - A
Digoxin Onset - 30-60 min (PO); 5-30 min (IV)
Digoxin Duration - 6-8 days
Digoxin Adverse Effects - · Has ability to cause dysrhythmias especially in patients w/
hypokalemia or CKD
· Carefully monitor use w/ digoxin (hypokalemia risk)
· N/V, fatigue, anorexia, visual disturbances (seeing halos, yellow-green tinge or
blurring)
· Monitor serum drug levels to maintain therapeutic range
Digoxin Contraindications - · May worsen AV block or ventricular dysrhythmias
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