Pharmacology · patient case question
All of the following are recognised adverse effects of lisinopril EXCEPT:
Patient case: Controlled Hypertension, and a Moment of Lightheadedness
Patient: 63-year-old male
Chief Complaint: Scheduled restoration of tooth #30.
Background: Hypertension, well controlled for six years. Attends his physician regularly. Ate breakfast this morning.
Medications: Lisinopril 20 mg daily, hydrochlorothiazide 25 mg daily
Vital Signs: Pre-operative BP 132/80 mmHg · HR 74 bpm · RR 16 · T 98.4°F
Findings: Ten minutes into the procedure, reclined in the chair, he reports feeling lightheaded. He is conscious, speaking normally, mildly pale, skin slightly moist. No chest pain, no shortness of breath, no weakness or slurred speech.
Show answer and explanation
Correct answer: B. Maculopapular rash
- A. This IS characteristic, and it is the commonest reason patients stop the drug — a dry, tickling, non-productive cough affecting roughly 5–20% of users. It arises because ACE also degrades BRADYKININ; inhibiting the enzyme lets bradykinin accumulate in the airways.
- B. CORRECT — this is the EXCEPTION. Rash is not among the characteristic adverse effects of ACE inhibitors. It can occur with almost any drug, but it is not what this class is known for and it is not what the question is testing.
- C. This IS characteristic. Reduced angiotensin II means reduced aldosterone, which means potassium retention. It is why potassium-sparing diuretics and potassium supplements are used cautiously with ACE inhibitors.
- D. This IS characteristic and it is the dangerous one. ACE-inhibitor angioedema is bradykinin-mediated, so it does NOT respond to antihistamines or corticosteroids, and it can present as sudden swelling of the lips, tongue or larynx years into therapy. It is a genuine airway emergency.
Note: Lisinopril is an ANGIOTENSIN-CONVERTING ENZYME INHIBITOR — it blocks the conversion of angiotensin I to angiotensin II. ⚑ It is NOT a diuretic. That miskeying recurs across several files in this series; correct it wherever you see it.