Names and pronunciation
(kwin′a-pril) Accupril
PDF page 1115
Loading InternPractice…
Drug reference
(kwin′a-pril) Accupril
PDF page 1115
Func. class.: Antihypertensive
PDF page 1115
Chem. class.: (ACE) inhibitor
PDF page 1115
Do not confuse: Accupril/Aciphex
PDF page 1115
ACTION: Selectively suppresses renin- angiotensin-aldosterone system; inhibits ACE, prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial, venous vessels
PDF page 1115
USES: Hypertension, alone or in com- bination with thiazide diuretics; systolic HF
PDF page 1115
CONTRAINDICATIONS: Children, hypersensitivity to ACE inhibitors, angio- edema
PDF page 1115
Black Box Warning: Pregnancy Q Precautions: Breastfeeding, geriatric patients, impaired renal/hepatic function, dialysis patients, hypovolemia, blood dys- crasias, bilateral renal stenosis, cough, hyperkalemia, aortic stenosis, African descent Black Box Warning: Do not use in preg- nancy, breastfeeding, stop drug if preg- nancy is determined Black Box Warning: Pregnancy: to re- port if pregnancy is planned or suspect- ed; not to breastfeed
PDF pages 1115, 1116, 1117
SIDE EFFECTS CNS: Headache, dizziness, fatigue, somnolence, depression, malaise, ner- vousness, vertigo, syncope CV: Hypotension, postural hypotension, syncope, palpitations, angina pecto- ris, MI, tachycardia, vasodilation, chest pain GI: Nausea, diarrhea, constipation, vom- iting, gastritis, GI hemorrhage, dry mouth GU: Increased BUN, creatinine; decreased libido, impotence INTEG: Angioedema, rash, sweating, pho- tosensitivity, pruritus META: Hyperkalemia MISC: Back pain, amblyopia MS: Myalgia RESP: Dry cough, pharyngitis, dyspnea
PDF page 1116
INTERACTIONS Increase: hyperkalemia—vasodilators, hydrALAZINE, prazosin, potassium- sparing diuretics, sympathomimetics, potassium supplements, ACE/angiotensin II receptor antagonists; aliskiren (dia- betic patients) Increase: hypotension—diuretics, other antihypertensives, ganglionic blockers, adrenergic blockers, phenothiazines, nitrates, acute alcohol ingestion Increase: toxicity of lithium Decrease: absorption of tetracycline, quinolone antibiotics Decrease: hypotensive effect of quinapril— NSAIDs Drug/Herb Decrease: antihypertensive effect—black licorice, ma huang, yohimbe Drug/Food Hyperkalemia: do not use with potas- sium-containing salt substitutes; read la- bel carefully Drug/Lab Test Increase: potassium, creatinine, BUN, LFTs False negative: aldosterone/renin ratio
PDF page 1116
TREATMENT OF OVERDOSE: 0.9% NaCl IV infusion
PDF page 1117
DOSAGE AND ROUTES Hypertension • Adult: PO 10-20 mg/day initially, then 20-80 mg/day divided bid or daily (monotherapy); start at 5 mg/day (with diuretics), titrate ≥2 wk up to 80 mg/day • Geriatric: PO 10 mg/day, titrate to de- sired response (monotherapy); start at 2.5 mg/day (with diuretics) Heart failure • Adult: PO 5 mg bid, may increase weekly until 20-40 mg/day in 2 divided doses Renal dose • Adult: PO CCr 61-89 mL/min 10 mg daily (hypertension), 5 mg bid (heart fail- ure); CCr 30-60 mL/min, 5 mg/day ini- tially; CCr 10-29 mL/min, 2.5 mg/day initially
PDF pages 1115, 1116
Available forms: Tabs 5, 10, 20, 40 mg
PDF page 1116
Administer: • Tabs may be crushed if necessary • Store in airtight container at room temperature • Do not use with high-fat meal, de- creases absorption
PDF page 1116
Assess: • Hypertension: B/P, orthostatic hypo- tension, syncope; monitor B/P before giving dose and after 2 hr; African- American patients are more resistant to antihypertension effect • Heart failure: edema in feet, legs daily; weight daily • Collagen-vascular disease: blood studies: neutrophils, decreased platelets; WBC with differential at baseline, periodi- cally, q3mo; if neutrophils <1000/mm3, discontinue treatment • Renal studies: protein, BUN, creati- nine; watch for increased levels; may in- dicate nephrotic syndrome • Baselines of hepatic studies before therapy, periodically; increased LFTs; uric acid, glucose may be increased • Potassium levels; hyperkalemia is rare, those with diabetes, renal disease are more at risk for hyperkalemia • Allergic reactions: angioedema, rash, fever, pruritus, urticaria, swelling of eyes/ face/throat/neck, SOB, difficulty breathing; product should be discontinued; angioede- ma is more common in African-Ameri- can patients
PDF page 1116
Evaluate: • Therapeutic response: decrease in B/P
PDF page 1117
CLINICAL CONSIDERATIONS
PDF page 1116
Patient and caregiver information: • Not to discontinue product abruptly • Not to use OTC products (cough, cold, allergy); not to use salt substitutes con- taining potassium unless directed by pre- scriber, to avoid high-fat meal at same time as product • To comply with dosage schedule, even if feeling better • To rise slowly to sitting or standing posi- tion to minimize orthostatic hypotension, to report excessive perspiration, dehydration, vomiting, diarrhea; may lead to fall in B/P; maintain adequate hydration, assess fall risk • To notify prescriber of mouth sores, sore throat, fever, swelling of hands/feet, irregular heartbeat, chest pain, persistent dry cough • To report signs of infection (fever, sore throat) • That product may cause dizziness, fainting, light-headedness; may occur during first few days of therapy • That product may cause skin rash, impaired taste perception • How to take B/P, normal readings for age group or individual baseline B/P and HR
PDF page 1117
PHARMACOKINETICS Bioavailability ≥60%, onset <1 hr, peak 1-2 hr, duration 24 hr, protein binding 97%, half-life 2 hr, metabolized by liver (active metabolite quinaprilat), metabo- lites excreted in urine (60%)/feces (37%)
PDF page 1116
• Adult: PO 10-20 mg/day initially, then 20-80 mg/day divided bid or daily (monotherapy); start at 5 mg/day (with diuretics), titrate ≥2 wk up to 80 mg/day
PDF pages 1115, 1116
• Geriatric: PO 10 mg/day, titrate to de- sired response (monotherapy); start at 2.5 mg/day (with diuretics) Heart failure
PDF pages 1115, 1116
• Adult: PO 5 mg bid, may increase weekly until 20-40 mg/day in 2 divided doses Renal dose
PDF pages 1115, 1116
• Adult: PO CCr 61-89 mL/min 10 mg daily (hypertension), 5 mg bid (heart fail- ure); CCr 30-60 mL/min, 5 mg/day ini- tially; CCr 10-29 mL/min, 2.5 mg/day initially
PDF pages 1115, 1116