Comprehensive Nursing Pharmacology Q 56
A nurse is providing instructions to a client regarding quinapril hydrochloride (Accupril). The nurse tells the client:
A. To take the medication with food only.
B. To rise slowly from a lying to a sitting position.
C. To discontinue the medication if nausea occurs.
D. That a therapeutic effect will be noted immediately.
Correct Answer: B. To rise slowly from a lying to a sitting position.
Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. Quinapril is a non-sulfhydryl ACE inhibitor that acts by blocking the action of ACE, which plays a vital role in the renin-angiotensin-aldosterone system (RAAS). Quinapril is metabolized into quinaprilat in the liver, from where the drug enters the circulation. After conversion, the liver releases quinaprilat into the peripheral circulation where it inhibits ACE; the enzyme is responsible for the conversion of angiotensin I to angiotensin II. Angiotensin II is the hormone that promotes the stimulation of the hormone aldosterone, which is responsible for salt and water retention.
Option A: The medication does not need to be taken with meals. It may be given without regard to food. The administration of quinapril is via the oral route. Plasma clearance of quinapril correlates to the creatinine clearance of a patient. Interestingly, twice daily dosing has been noted to achieve a more significant blood pressure trough effect in hypertensive patients as opposed to a similar total dose administered daily.
Option C: If nausea occurs, the client should be instructed to take a non-cola carbonated beverage and salted crackers or dry toast. Angioedema is a rare but well-documented side effect of ACE inhibitors, which often presents as facial, tongue, and lip swelling. However, there may be unique instances when patients present with isolated swelling of the small bowel. This presentation, also called intestinal-type angioedema, may manifest in patients taking ACE inhibitors that present with abdominal pain, nausea, vomiting, and/or diarrhea.
Option D: A full therapeutic effect may be noted in 1 to 2 weeks. Quinapril (and its metabolite quinaprilat) decreases systemic (peripheral and renal) vascular resistance, thereby decreasing blood pressure. Distribution is widespread, except for brain tissue. The renal system clears the majority of quinapril, and the maximum observable effect of ACE inhibitors takes place at 5 hours.