User Tools

Site Tools

Trace: • lectures
templates:drug

Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revisionPrevious revision
Next revision		Previous revision
templates:drug [2026/03/15 16:53] – andrew2393cnstemplates:drug [2026/03/15 17:00] (current) – Restore master drug template wilkie
Line 1: Line 1:
-====== Lisinopril (Prinivil®, Zestril®) ====== +====== Lisinopril (Prinivil®, Zestril®) ======<WRAP right 340px><WRAP infobox>| | {{ :cardio:raas:lisinopril_structure.svg |}} |^ Lisinopril || Brand Names | Prinivil®, Zestril® || Drug Class | [[cardio:raas:acei|ACE Inhibitor]] || Primary Indications | [[cardio:hypertension:start|Hypertension]]; [[cardio:heart_failure:start|Heart Failure (HFrEF)]]; Post-MI || Blood Pressure Effect | ↓ SVR || Mortality Benefit | Yes (HFrEF, post-MI) || Elimination | Renal || Black Box Warning | Fetal Toxicity || FDA Approval | 1987 |</WRAP></WRAP>===== Overview =====Lisinopril is a long-acting [[cardio:raas:acei|angiotensin-converting enzyme (ACE) inhibitor]] used in the treatment of [[cardio:hypertension:start|hypertension]], [[cardio:heart_failure:start|heart failure with reduced ejection fraction]], and post–myocardial infarction ventricular dysfunction.It reduces systemic vascular resistance, decreases aldosterone-mediated sodium retention, and mitigates maladaptive neurohormonal activation. Lisinopril improves survival in HFrEF and post-MI patients and remains a cornerstone agent in cardiometabolic therapy.<WRAP clear></WRAP>----===== Mechanism of Action =====**Primary Molecular Target**  * Inhibition of angiotensin-converting enzyme (ACE)**RAAS Effects**  * ↓ Conversion of Angiotensin I → Angiotensin II  * ↓ Aldosterone secretion  * ↓ Vasoconstriction**Bradykinin Effect**  * ↑ Bradykinin levels (due to reduced breakdown)**Net Physiologic Outcomes**  * ↓ Systemic vascular resistance (afterload)  * ↓ Sodium and water retention  * ↓ Ventricular remodeling  * Improved cardiac output in HFrEF----===== Indications =====  * [[cardio:hypertension:start|Hypertension]]  * [[cardio:heart_failure:start|Heart Failure (HFrEF)]]  * Post–myocardial infarction with LV dysfunctionRenal protection:  * Diabetic nephropathy (albuminuria reduction)----<WRAP blackbox>===== Black Box Warning =====ACE inhibitors can cause fetal toxicity when administered during pregnancy.Mechanism:  * Disruption of fetal RAAS  * Risk of renal failure, oligohydramnios, skull hypoplasiaDiscontinue immediately if pregnancy is detected.</WRAP>----<WRAP contra>===== Contraindications =====Absolute:  * History of ACE inhibitor–induced angioedema  * Pregnancy  * Bilateral renal artery stenosisRelative / Caution:  * Hyperkalemia  * Severe renal impairment  * Volume depletion</WRAP>----<WRAP details>===== Dosing =====Hypertension:  * Initial: 10 mg daily  * Typical: 20–40 mg daily  * Max: 40 mg dailyHeart Failure:  * Initial: 2.5–5 mg daily  * Titrate upward as toleratedRenal adjustment:  * Required in reduced eGFR</WRAP>----<WRAP details>===== Pharmacokinetics =====Absorption:  * OralBioavailability:  * ~25%Metabolism:  * Not metabolizedHalf-life:  * ~12 hoursElimination:  * Renal (unchanged)</WRAP>----<WRAP details>===== Adverse Effects =====Common:  * Dry cough (bradykinin-mediated)  * Dizziness  * HypotensionElectrolyte:  * HyperkalemiaSerious:  * Angioedema  * Acute kidney injury (in bilateral RAS)</WRAP>----<WRAP details>===== Drug Interactions =====Increased hyperkalemia risk:  * [[cardio:diuretics:mra|Potassium-Sparing Diuretics]]  * Potassium supplementsRenal function risk:  * NSAIDs  * Volume depletionAvoid combination:  * ACE inhibitor + [[cardio:raas:arb|ARB]]  * ACE inhibitor + [[cardio:raas:direct_renin_inhibitor|Direct Renin Inhibitor]]</WRAP>----<WRAP monitoring>===== Monitoring =====Labs:  * Serum creatinine  * PotassiumVitals:  * Blood pressureClinical:  * Cough  * Angioedema symptoms</WRAP>----<WRAP pearls>===== Clinical Pearls =====  * Mortality benefit in HFrEF  * Renoprotective in diabetes  * Cough due to bradykinin accumulation  * First-line in many hypertension guidelines  * Hold during acute kidney injury or dehydration</WRAP>----===== Comparison Within Class =====Compared to other [[cardio:raas:acei|ACE inhibitors]]:  * Not a prodrug (active form)  * Long duration (once-daily dosing)  * Fully renally cleared  * Similar mortality benefit to enalapril in HFrEF----===== Related =====  * [[cardio:raas:acei|ACE Inhibitors]]  * [[cardio:hypertension:start|Hypertension Module]]  * [[cardio:heart_failure:start|Heart Failure Module]]  * [[cardio:intro:start|Cardiovascular Pharmacology]]
- +
-<WRAP right 340px> +
-<WRAP infobox> +
-| | {{ :cardio:raas:lisinopril_structure.svg |}} | +
-^ Lisinopril | +
-| Brand Names | Prinivil®, Zestril® | +
-| Drug Class | [[cardio:raas:acei|ACE Inhibitor]] | +
-| Primary Indications | [[cardio:hypertension:start|Hypertension]]; [[cardio:heart_failure:start|Heart Failure (HFrEF)]]; Post-MI | +
-| Blood Pressure Effect | ↓ SVR | +
-| Mortality Benefit | Yes (HFrEF, post-MI) | +
-| Elimination | Renal | +
-| Black Box Warning | Fetal Toxicity | +
-| FDA Approval | 1987 | +
-</WRAP> +
-</WRAP> +
- +
-===== Overview ===== +
- +
-Lisinopril is a long-acting [[cardio:raas:acei|angiotensin-converting enzyme (ACE) inhibitor]] used in the treatment of [[cardio:hypertension:start|hypertension]], [[cardio:heart_failure:start|heart failure with reduced ejection fraction]], and post–myocardial infarction ventricular dysfunction. +
- +
-It reduces systemic vascular resistance, decreases aldosterone-mediated sodium retention, and mitigates maladaptive neurohormonal activation. Lisinopril improves survival in HFrEF and post-MI patients and remains a cornerstone agent in cardiometabolic therapy. +
- +
-<WRAP clear></WRAP> +
- +
----- +
- +
-===== Mechanism of Action ===== +
- +
-**Primary Molecular Target** +
-  * Inhibition of angiotensin-converting enzyme (ACE) +
- +
-**RAAS Effects** +
-  * ↓ Conversion of Angiotensin I → Angiotensin II +
-  * ↓ Aldosterone secretion +
-  * ↓ Vasoconstriction +
- +
-**Bradykinin Effect** +
-  * ↑ Bradykinin levels (due to reduced breakdown) +
- +
-**Net Physiologic Outcomes** +
-  * ↓ Systemic vascular resistance (afterload) +
-  * ↓ Sodium and water retention +
-  * ↓ Ventricular remodeling +
-  * Improved cardiac output in HFrEF +
- +
----- +
- +
-===== Indications ===== +
- +
-  * [[cardio:hypertension:start|Hypertension]] +
-  * [[cardio:heart_failure:start|Heart Failure (HFrEF)]] +
-  * Post–myocardial infarction with LV dysfunction +
- +
-Renal protection: +
-  * Diabetic nephropathy (albuminuria reduction) +
- +
----- +
- +
-<WRAP blackbox> +
-===== Black Box Warning ===== +
- +
-ACE inhibitors can cause fetal toxicity when administered during pregnancy. +
- +
-Mechanism: +
-  * Disruption of fetal RAAS +
-  * Risk of renal failure, oligohydramnios, skull hypoplasia +
- +
-Discontinue immediately if pregnancy is detected. +
-</WRAP> +
- +
----- +
- +
-<WRAP contra> +
-===== Contraindications ===== +
- +
-Absolute: +
-  * History of ACE inhibitor–induced angioedema +
-  * Pregnancy +
-  * Bilateral renal artery stenosis +
- +
-Relative / Caution: +
-  * Hyperkalemia +
-  * Severe renal impairment +
-  * Volume depletion +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Dosing ===== +
- +
-Hypertension: +
-  * Initial: 10 mg daily +
-  * Typical: 20–40 mg daily +
-  * Max: 40 mg daily +
- +
-Heart Failure: +
-  * Initial: 2.5–5 mg daily +
-  * Titrate upward as tolerated +
- +
-Renal adjustment: +
-  * Required in reduced eGFR +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Pharmacokinetics ===== +
- +
-Absorption: +
-  * Oral +
- +
-Bioavailability: +
-  * ~25% +
- +
-Metabolism: +
-  * Not metabolized +
- +
-Half-life: +
-  * ~12 hours +
- +
-Elimination: +
-  * Renal (unchanged) +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Adverse Effects ===== +
- +
-Common: +
-  * Dry cough (bradykinin-mediated) +
-  * Dizziness +
-  * Hypotension +
- +
-Electrolyte: +
-  * Hyperkalemia +
- +
-Serious: +
-  * Angioedema +
-  * Acute kidney injury (in bilateral RAS) +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Drug Interactions ===== +
- +
-Increased hyperkalemia risk: +
-  * [[cardio:diuretics:mra|Potassium-Sparing Diuretics]] +
-  * Potassium supplements +
- +
-Renal function risk: +
-  * NSAIDs +
-  * Volume depletion +
- +
-Avoid combination: +
-  * ACE inhibitor + [[cardio:raas:arb|ARB]] +
-  * ACE inhibitor + [[cardio:raas:direct_renin_inhibitor|Direct Renin Inhibitor]] +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP monitoring> +
-===== Monitoring ===== +
- +
-Labs: +
-  * Serum creatinine +
-  * Potassium +
- +
-Vitals: +
-  * Blood pressure +
- +
-Clinical: +
-  * Cough +
-  * Angioedema symptoms +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP pearls> +
-===== Clinical Pearls ===== +
- +
-  * Mortality benefit in HFrEF +
-  * Renoprotective in diabetes +
-  * Cough due to bradykinin accumulation +
-  * First-line in many hypertension guidelines +
-  * Hold during acute kidney injury or dehydration +
- +
-</WRAP> +
- +
----- +
- +
-===== Comparison Within Class ===== +
- +
-Compared to other [[cardio:raas:acei|ACE inhibitors]]: +
- +
-  * Not a prodrug (active form) +
-  * Long duration (once-daily dosing) +
-  * Fully renally cleared +
-  * Similar mortality benefit to enalapril in HFrEF +
- +
----- +
- +
-===== Related ===== +
- +
-  * [[cardio:raas:acei|ACE Inhibitors]] +
-  * [[cardio:hypertension:start|Hypertension Module]] +
-  * [[cardio:heart_failure:start|Heart Failure Module]] +
-  * [[cardio:intro:start|Cardiovascular Pharmacology]]+
templates/drug.1773593586.txt.gz · Last modified: by andrew2393cns