In this episode of Think Like a Nurse, we break down one of the most common—and most testable—cardiac medications in nursing: lisinopril, the cornerstone ACE inhibitor. Brooke Wallace, 20-year ICU and transplant nurse, walks through how lisinopril works within the renin-angiotensin-aldosterone system, when it’s prescribed, and what every nurse must monitor. You’ll learn the high-yield ACE mnemonic—Angioedema, Cough, Elevated Potassium—to remember the “Big Three” safety concerns that can make or break safe patient care and NCLEX success. From understanding first-dose hypotension and renal adjustments to spotting early signs of angioedema, this episode delivers practical, clinically grounded pearls that help you think like a nurse in real-world settings.
Episode Notes:
Drug: Lisinopril
Class: ACE inhibitor (angiotensin-converting enzyme inhibitor)
Mechanism: Blocks conversion of angiotensin one → angiotensin two, leading to vasodilation, reduced afterload, and decreased aldosterone secretion.
Therapeutic Uses: Hypertension, heart failure, post-MI, diabetic nephropathy (renal protection).
Contraindications: Pregnancy (Category D), prior angioedema from ACE inhibitors, bilateral renal artery stenosis.
Major Adverse Effects (Mnemonic – ACE):
A: Angioedema – airway emergency, stop drug immediately
C: Cough – persistent, dry, brady-kinen buildup
E: Elevated potassium – risk for hyperkalemia, monitor labs and EKG
Nursing Priorities:
Monitor potassium, creatinine, and blood pressure (watch for first-dose hypotension)
Teach patients to avoid potassium supplements, salt substitutes, and NSAIDs
Educate about orthostatic safety and consistent daily dosing
Use teach-back method to ensure understanding
NCLEX Tip: Remember the ACE mnemonic for test questions on adverse effects and safety monitoring.