AANP Family Nurse Practitioner (FNP) Certification ExamPlanMedium
A 55-year-old male with type 2 diabetes and hypertension is prescribed lisinopril 10 mg daily. He reports experiencing a persistent dry cough since starting the medication a few weeks ago. His blood pressure is well-controlled. Which of the following is the most appropriate next step in managing this patient?
- AIncrease the dose of lisinopril to 20 mg daily.
- BSwitch lisinopril to losartan 50 mg daily.
- CAdd a cough suppressant to his medication regimen.
- DDiscontinue lisinopril and monitor blood pressure.
Show answer & explanationAnswer & explanation
Correct answer: B. Switch lisinopril to losartan 50 mg daily.
A persistent dry cough is a common and bothersome side effect of ACE inhibitors like lisinopril. Switching to an angiotensin receptor blocker (ARB) such as losartan is the most appropriate next step, as ARBs do not cause this cough and are equally effective in managing hypertension and providing renoprotection in diabetes.
Why the other options are wrong
- A. Increasing the dose of lisinopril would likely worsen the cough, as it is a dose-dependent side effect.
- C. Adding a cough suppressant would only mask the symptom without addressing the underlying cause and is not a definitive solution for an ACE inhibitor-induced cough.
- D. Discontinuing lisinopril without replacing it with another antihypertensive would leave his hypertension untreated, which is not appropriate given his comorbidities.
ACE Inhibitor Cough Management
A common side effect of ACE inhibitors is a persistent dry cough; management involves switching to an Angiotensin Receptor Blocker (ARB).
- Cough is due to bradykinin accumulation.
- ARBs do not affect bradykinin, thus do not cause the cough.
- ARBs have similar cardiovascular and renal protective benefits as ACEIs.
Memory trick: When ACEI makes you cough, ARB is the smooth switch.