Monopril
fosinopril sodium
Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
Action
Prevents conversion of angiotensin I to the vasoconstrictor angiotensin II, thereby reducing sodium and water retention and enhancing blood flow in circulatory system
Availability
Tablets: 10 mg, 20 mg, 40 mg
Indications and dosages
➣ Hypertension
Adults: 10 mg P.O. daily. May increase as required up to 80 mg/day; typical range is 20 to 40 mg P.O. daily.
➣ Heart failure
Adults: 10 mg P.O. daily. May increase over several weeks up to 40 mg/day; typical range is 20 to 40 mg/day.
Dosage adjustment
• Renal impairment
Off-label uses
• Adjunct in myocardial infarction
• Nephropathy
Contraindications
• Hypersensitivity to drug or other ACE inhibitors
• Angioedema (hereditary or idiopathic)
• Pregnancy
Precautions
Use cautiously in:
• aortic stenosis, cardiomyopathy, cerebrovascular or cardiac insufficiency, renal or hepatic impairment, hyponatremia, hypovolemia
• black patients with hypertension
• patients receiving diuretics concurrently
• elderly patients
• breastfeeding patients (safety not established)
• children (safety not established).
Administration
• Don't administer within 2 hours of antacids.
• Give with or without food, but avoid giving with high-potassium foods or potassium supplements.
Adverse reactions
CNS: dizziness, drowsiness, fatigue, headache, insomnia, weakness, vertigo
CV: hypotension, angina pectoris, tachycardia
EENT: sinusitis
GI: nausea, vomiting, diarrhea, anorexia
GU: proteinuria, erectile dysfunction, decreased libido, renal failure
Hematologic: agranulocytosis, bone marrow depression
Metabolic: hyperkalemia
Respiratory: cough, bronchitis, dyspnea, asthma, eosinophilic pneumonitis
Skin: rash, angioedema
Other: altered taste, fever, hypersensitivity reactions including anaphylaxis
Interactions
Drug-drug. Allopurinol: increased risk of hypersensitivity reaction
Antacids: decreased fosinopril absorption
Antihypertensives, diuretics, general anesthetics, nitrates, phenothiazines: additive hypotension
Cyclosporine, indomethacin, potassium-sparing diuretics, potassium supplements: hyperkalemia
Digoxin, lithium: increased blood levels of these drugs, greater risk of toxicity
Indomethacin: decreased hypotensive effects
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, potassium: increased levels
Antinuclear antibody titer: false-positive result
Sodium: decreased level
Drug-food. Salt substitutes containing potassium: hyperkalemia
Drug-herbs. Capsaicin: increased incidence of cough
Drug-behaviors. Acute alcohol ingestion: additive hypotension
Patient monitoring
• Monitor cardiovascular, respiratory, and neurologic status.
• Monitor CBC and liver and kidney function tests.
• Measure blood pressure to assess drug efficacy and detect hypotension.
• Assess patient's potassium intake; monitor serum potassium level.
See Monitor for signs and symptoms of angioedema and anaphylaxis. If these occur, withdraw drug and contact prescriber immediately.
Patient teaching
See Instruct patient to immediately report rash or difficulty breathing.
• Tell patient to report dizziness, fainting, bleeding tendency, change in urination pattern, swelling, or persistent cough.
• Encourage patient to drink enough fluids to stay well hydrated.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Instruct female patient to notify prescriber if she suspects she is pregnant.
• Tell patient that he will undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.
fosinopril
(foe-sin-oh-pril) fosinopril,Monopril
(trade name)Classification
Therapeutic: antihypertensivesPharmacologic: ace inhibitors
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (effect on BP—single dose†)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | Within 1 hr | 2–6 hr | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness (most frequent)
- fatigue
- headache
- insomnia
- weakness
Respiratory
- cough (most frequent)
Cardiovascular
- hypotension (most frequent)
- chest pain
- edema
Gastrointestinal
- abdominal pain
- diarrhea
- nausea
- vomiting
Genitourinary
- erectile dysfunction
- impaired renal function
Dermatologic
- rash
Fluid and Electrolyte
- hyperkalemia
Musculoskeletal
- muscle cramps
Respiratory
- dyspnea
Miscellaneous
- angioedema (life-threatening)
Interactions
Drug-Drug interaction
Excessive hypotension may occur with concurrent use of diuretics.Additive hypotension with other antihypertensive agents.↑ risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes.↑ risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor antagonists or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/minNSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.Absorption may be ↓ by antacids (separate administration by 1–2 hr).↑ levels and may ↑ the risk of lithium toxicity.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Hypertension: Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
- Monitor frequency of prescription refills to determine compliance.
- Assess patient for signs of angioedema (dyspnea, facial swelling).
- Heart Failure: Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
- Lab Test Considerations: Monitor renal function. May cause ↑ in BUN and serum creatinine.
- May cause hyperkalemia.
- Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause slight ↓ in hemoglobin and hematocrit as well as neutropenia and eosinophilia.
- May cause ↑ AST, ALT, alkaline phosphatase, and serum bilirubin.
Potential Nursing Diagnoses
Decreased cardiac output (Indications, Side Effects)Noncompliance (Patient/Family Teaching)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
- Correct volume depletion, if possible, before initiation of therapy due to possible precipitous drop in BP during first 1–3 hr following first dose. Risk of hypotension may be decreased by discontinuing diuretics or cautiously increasing salt intake 2–3 days prior to beginning fosinopril. Monitor BP closely. Resume diuretics if BP is not controlled.
Patient/Family Teaching
- Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double dose. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional.
- Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional (see ).
- Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially OTC cough, cold, or allergy remedies.
- May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise patient to inform health care professional of medication regimen before treatment or surgery.
- Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
- Advise women of childbearing age to use contraception and notify health care professional of pregnancy is planned or suspected.
- Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.
- Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
- Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.
Evaluation/Desired Outcomes
- Decrease in BP without appearance of excessive side effects.
- Decrease in signs and symptoms of heart failure.