ACE Angie — ACE Inhibitors: Cough, Angioedema & Hyperkalemia
Lisinopril lowers her blood pressure beautifully — until the dry cough starts and her lips begin to swell
Angie started lisinopril three weeks ago and her blood pressure is finally controlled, but now she cannot stop coughing — a dry, hacking tickle that keeps her up at night. This morning she notices her lips look swollen.
Angie takes lisinopril for hypertension, and it works by blocking the conversion of angiotensin I to angiotensin II, dropping her blood pressure and protecting her kidneys. But ACE inhibitors also block the breakdown of bradykinin, and bradykinin buildup causes the two signature problems: a persistent dry, tickling cough and, far more dangerous, angioedema of the lips, tongue and airway. Because less aldosterone is released, potassium is retained, so ACE inhibitors also raise serum potassium — especially with potassium-sparing diuretics or salt substitutes.
Read ACE Angie's full story →The story arc
The setup
Angie is prescribed lisinopril for stage 2 hypertension and is told it will also protect her kidneys because she has diabetes.
The turn
Two weeks in, Angie develops a dry, nonproductive cough that is worse at night and does not respond to cough syrup.
The crisis
One morning Angie's lips and tongue begin to swell and her voice sounds muffled and thick.
The save
The nurse stops the lisinopril immediately, prepares for airway management, and the provider switches Angie to an ARB with instructions to never take an ACE inhibitor again.
NCLEX study section — ACE Inhibitors: Cough, Angioedema & Hyperkalemia
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pharmacology
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