Pharmacology · patient case question
What is the mechanism of action of lisinopril?
Patient case: Polypharmacy — Cardiovascular & GI
demo: 68-year-old male
chief: “I need a crown on my lower left molar.”
history: Hypertension, gastroesophageal reflux disease, atrial fibrillation, hyperlipidemia, gout. Non-smoker.
meds: Lisinopril, omeprazole, verapamil, apixaban, rosuvastatin, allopurinol
findings: BP 132/84 mmHg. Generalized attrition. Tooth #19 with fractured MOD amalgam, no pulpal symptoms. No active periodontal disease.
Show answer and explanation
Correct answer: D. Blocks angiotensin-converting enzyme, preventing conversion of angiotensin I to angiotensin II
- A. That describes an ARB such as losartan or valsartan. ARBs act downstream at the receptor and do not raise bradykinin, which is why they rarely cause the dry cough.
- B. That describes a thiazide diuretic such as hydrochlorothiazide.
- C. That describes a direct renin inhibitor such as aliskiren.
- D. Correct. Lisinopril is an ACE inhibitor. Blocking the conversion of angiotensin I to angiotensin II produces vasodilation and lowers peripheral resistance; renin and angiotensin I levels rise as a consequence.