Search your Drugs Here

Tuesday, February 8, 2011

quinapril hydrochloride

Posted by Sampil 11:59 PM, under | No comments

quinapril hydrochloride
(kwin' ah pril)
Accupril

Pregnancy Category C (first trimester)
Pregnancy Category D (second and third trimesters)

Drug classes
Antihypertensive
ACE inhibitor

Therapeutic actions
Quinapril blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.

Indications
·        Treatment of hypertension alone or in combination with thiazide-type diuretics
·        Adjunctive therapy in the management of CHF with cardiac glycosides, diuretics, and beta-adrenergic blockers

Contraindications and cautions
·        Contraindicated with allergy to quinapril or other ACE inhibitors, pregnancy, angioedema.
·        Use cautiously with impaired renal function, unilateral, bilateral renal artery stenosis, salt or volume depletion, lactation.

Available forms
Tablets—5, 10, 20, 40 mg

Dosages
ADULTS
·        Hypertension: Initial dose, 10 or 20 mg PO daily. Maintenance dose, 20–80 mg/day PO as a single dose or two divided doses. Patients on diuretics should discontinue the diuretic 2–3 days before beginning benazepril therapy. If BP is not controlled, add diuretic slowly. If diuretic cannot be discontinued, beginquinapril therapy with 5 mg and monitor carefully for hypotension.
·        CHF: Initial dose, 5 mg PO bid. Dose may be increased as needed to relieve symptoms; usual range, 10–20 mg PO bid; increase doses at weekly intervals until effective dose is reached.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT
Initial dose: 10 mg if creatinine clearance > 60 mL/min, 5 mg if creatinine clearance 30–60 mL/min, 2.5 mg if creatinine clearance 10–30 mL/min.

Pharmacokinetics
Route
Onset
Peak
Duration
Oral
1 hr
1 hr
24 hr

Metabolism: Hepatic; T1/2: 2 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
·        CV: Angina pectoris, orthostatic hypotension in salt- or volume-depleted patients, palpitations
·        Dermatologic: Rash, pruritus, diaphoresis, flushing, photosensitivity
·        GI: Elevated LFTs, pancreatitis
·        Respiratory: Cough
·        Other: Angioedema, arthralgia

Interactions
·        Increased lithium levels
·        Decreased tetracycline absorption. Separate drugs by 1–2 hr.

Nursing considerations
Assessment
·        History: Allergy to quinapril, other ACE inhibitors; impaired renal function; CHF; salt or volume depletion; lactation, pregnancy
·        Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC and differential

Interventions
·        WARNING: Alert surgeon and mark patient's chart with notice that quinapril is being taken; the angiotensin II formation subsequent to compensatory reninrelease during surgery will be blocked; hypotension may be reversed with volume expansion.
·        WARNING: Caution patient that this drug should not be used during pregnancy; advise the use of barrier contraceptives.
·        Monitor patient closely in any situation that may lead to a fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.

Teaching points
·        Do not stop taking the medication without consulting your health care provider.
·        Be careful in any situation that may lead to a drop in blood pressure (diarrhea, sweating, vomiting, dehydration); if light-headedness or dizziness should occur, consult your health care provider.
·        This drug should not be used during pregnancy; using barrier contraceptives is advised.
·        You may experience these side effects: GI upset, loss of appetite (transient); light-headedness (usually transient; change position slowly and limit activities to those that do not require alertness and precision); dry cough (not harmful).
·        Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue; difficulty breathing; persistent cough.

Adverse effects in Italic are most common; those in Bold are life-threatening.

0 comments:

Post a Comment

Tags

Blog Archive

Blog Archive