quinapril hydrochloride

(kwin' ah pril)
Accupril

Pregnancy Category C (first trimester)

Pregnancy Category D (second and third trimesters)

Drug classes
Antihypertensive
Angiotensin converting enzyme (ACE) inhibitor

Therapeutic actions
Quinapril blocks ACE from converting angiotensin I to angiotensin II, a powerful
vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a small
increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin
synthesis also may be involved in the antihypertensive action.

Indications
• Treatment of hypertension alone or in combination with thiazide-type diuretics
• Adjunctive therapy in the management of CHF with cardiac glycosides, diuretics,
and beta-adrenergic blockers

Contraindications and cautions

• Contraindicated with allergy to quinapril or other ACE inhibitors, pregnancy,
angioedema.
• Use cautiously with impaired renal function, unilateral, bilateral renal artery
stenosis, salt or volume depletion, lactation.

Available forms
Tablets—5, 10, 20, 40 mg

Dosages
ADULTS
• Hypertension: Initial dose, 10 or 20 mg PO daily. Maintenance dose, 20–
80 mg/day PO as a single dose or 2 divided doses. Patients on diuretics should
discontinue the diuretic 2–3 days before beginning benazepril therapy. If BP is not
controlled, add diuretic slowly. If diuretic cannot be discontinued, begin quinapril
therapy with 5 mg and monitor carefully for hypotension.
• CHF: Initial dose, 5 mg PO bid. Dose may be increased as needed to relieve
symptoms, 10–20 mg PO bid usual range.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT
Initial dose, 10 mg if creatinine clearance > 60 mL/min, 5 mg if creatinine clearance 30–
60 mL/min, 2.5 mg if creatinine clearance 10–30 mL/min.

Pharmacokinetics
Route Onset Peak Duration
Oral 1 hr 1 hr 24 hr

Metabolism: Hepatic; T1/2: 2 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CV: Angina pectoris, orthostatic hypotension in salt- or volume-depleted patients,
palpitations
• Dermatologic: Rash, pruritus, diaphoresis, flushing, photosensitivity
• GI: Elevated liver function tests, pancreatitis
• Respiratory: Cough
• Other: Angioedema, arthralgia

Interactions
Drug-drug
• Increased lithium levels
• Decreased tetracycline absorption. Separate drugs by 1–2 hr.

Nursing considerations
Assessment
• History: Allergy to quinapril, other ACE inhibitors; impaired renal function;
CHF; salt or volume depletion; lactation, pregnancy
• Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous
membranes, bowel sounds, liver evaluation; urinalysis, renal and liver function
tests, CBC and differential

Interventions
• Alert surgeon and mark patient's chart with notice that quinapril is being taken;
the angiotensin II formation subsequent to compensatory renin release during
surgery will be blocked; hypotension may be reversed with volume expansion.
• Caution patient that this drug should not be used during pregnancy; advise the use
of barrier contraceptives.
• Monitor patient closely in any situation that may lead to a fall in BP secondary to
reduction in fluid volume (excessive perspiration and dehydration, vomiting,
diarrhea) because excessive hypotension may occur.

Teaching points
• Do not stop taking the medication without consulting your health care provider.
• Be careful in any situation that may lead to a drop in BP (diarrhea, sweating,
vomiting, dehydration); if light-headedness or dizziness should occur, consult
your health care provider.
• This drug should not be used during pregnancy; barrier contraceptives are
advised.
 • These side effects may occur: GI upset, loss of appetite (transient); light-
headedness (usually transient; change position slowly and limit activities to those
that do not require alertness and precision); dry cough (not harmful).
• Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular
heartbeat, chest pains; swelling of the face, eyes, lips, tongue; difficulty breathing;
persistent cough.

Adverse effects in Italic are most common; those in Bold are life-threatening.