QUINAPRIL HYDROCHLORIDE

QUINAPRIL HYDROCHLORIDe
(quin'a-pril)
Accupril
Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive;
Therapeutic: antihypertensive
; ace inhibitor
Prototype: Enalapril
Pregnancy Category: C first trimester; D second and third trimester

Availability

5 mg, 10 mg, 20 mg, 40 mg tablets

Action

Potent, long-acting second-generation ACE inhibitor that lowers BP by interrupting the conversion sequences initiated by renin to form angiotensin II, a vasoconstrictor. Inhibition of ACE also decreases circulating aldosterone, a secretory response to angiotensin II stimulation. Reduces pulmonary capillary wedge pressure, systemic vascular resistance, and mean arterial pressure, with concurrent increases in cardiac output, cardiac index, and stroke volume.

Therapeutic Effect

Lowers BP by producing vasodilation. Effective in the treatment of CHF because it improves cardiac indicators.

Uses

Mild to moderate hypertension, CHF.

Contraindications

Hypersensitivity to quinapril or other ACE inhibitors; children; pregnancy (category C first trimester, category D second and third trimester), lactation.

Cautious Use

Renal insufficiency, severe CHF; autoimmune disease, volume-depleted patients, renal artery stenosis, neutropenia.

Route & Dosage

Hypertension, CHF
Adult: PO 10–20 mg q.d., may increase up to 80 mg/d in 1–2 divided doses
Geriatric: PO Start with 2.5–5 mg q.d.

Renal Insufficiency
Clcr 30–60 mL/min: 5 mg/q.d. initially; <10–30 mL/min: 2.5 mg/d initially

Administration

Oral
  • Discontinue diuretics 2–3 d before initiation of quinapril. Do NOT exceed initial dose of 5 mg if diuretics cannot be discontinued.
  • Store at 15°–30° C (59°–86° F) and protect from moisture.

Adverse Effects (≥1%)

CV: Edema, hypotension. CNS: Dizziness, fatigue, headache. GI: Nausea, vomiting, diarrhea. Hematologic: Eosinophilia, neutropenia. Metabolic: Hyperkalemia, proteinuria. Respiratory: Cough. Body as a Whole: Angioedema, myalgia.

Diagnostic Test Interference

May increase BUN or serum creatinine.

Interactions

Drug: potassium-sparing diuretics may increase risk of hyperkalemia. May elevate serum lithium levels, resulting in lithium toxicity.

Pharmacokinetics

Absorption: Rapidly from GI tract. Onset: 1 h. Peak: 2–4 h. Duration: Up to 24 h. Distribution: 97% bound to plasma proteins; crosses placenta; not known if distributed into breast milk. Metabolism: Extensively metabolized in liver to its active metabolite, quinaprilat. Elimination: 50–60% in urine, primarily as quinaprilat; 30% in feces. Half-Life: 2 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor BP at time of peak effectiveness, 2–4 h after dosing, and at end of dosing interval just before next dose.
  • Report diminished antihypertensive effect toward end of dosing interval. Inadequate trough response may indicate need to divide daily dose.
  • Monitor for first-dose hypotension, especially in salt- or volume-depleted clients.
  • Lab tests: Monitor BUN and serum creatinine periodically. Increases may necessitate dose reduction or discontinuation of drug. Monitor serum potassium values.
  • Observe for S&S of hyperkalemia (see Appendix F).

Patient & Family Education

  • Discontinue quinapril and report S&S of angioedema (e.g., swelling of face or extremities, difficulty breathing or swallowing) to physician.
  • Maintain adequate fluid intake and avoid potassium supplements or salt substitutes unless specifically prescribed by physician.
  • Note: A high-fat meal may lessen drug's absorption.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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