Lisinopril
Brand names: Prinivil, Zestril
Class: 💊 ACE Inhibitors & ARBs
For the FNP boards, lisinopril is the prototype ACE inhibitor and the first drug to start in a hypertensive diabetic with microalbuminuria. It blocks the conversion of angiotensin I to angiotensin II, lowering blood pressure, reducing afterload in HFrEF, and slowing proteinuric kidney decline. Indications include hypertension, heart failure, post-MI mortality reduction, and diabetic nephropathy. The two board-staple side effects are dry cough (bradykinin — switch to an ARB) and hyperkalemia. Avoid in pregnancy, bilateral renal artery stenosis, prior angioedema, and hyperkalemia. Check potassium and creatinine 1–2 weeks after starting; a creatinine bump under 30% is acceptable, over 30% means stop and reassess.
✅ Indications
HTN, CHF, post-MI, diabetic nephropathy, proteinuric CKD.
⚙️ Mechanism of Action
ACE inhibitor — blocks conversion of angiotensin I to angiotensin II; ↑ bradykinin.
📏 Dosing
10–40 mg PO daily. Start 5–10 mg; max 80 mg.
🚫 Contraindications
Pregnancy (all trimesters), bilateral renal artery stenosis, history of ACE-induced angioedema, hereditary angioedema.
⚠️ Adverse Effects
Dry cough (up to 20%), hyperkalemia, angioedema (rare but serious), AKI, dizziness, hypotension.
🔬 Monitoring
BP, K⁺, creatinine at baseline + 1–2 weeks after start or dose increase. Recheck with illness or new diuretic.
💎 Board Pearls
- 🚨 #1 ACE inhibitor prescribed in the US — default board answer for uncomplicated HTN + DM/CKD.
- 🫁 Dry cough = bradykinin mediated → switch to ARB (losartan).
- 💧 Stopping NSAIDs + hydrating often reverses the creatinine bump.
Related Drugs in This Class
Sources
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