Leukopenia and neutropenia have been reported with Prinivil (lisinopril) therapy. Which signs or symptoms should a patient promptly report because they may indicate leukopenia or neutropenia?
Explanation
Lisinopril (Prinivil) is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension, manage heart failure with reduced ejection fraction, and improve survival after acute myocardial infarction in hemodynamically stable patients.
For an adult with uncomplicated hypertension who is not taking a diuretic, the usual initial dose is 10 mg once daily. The usual dosage range is 20–40 mg once daily, adjusted according to blood pressure response.
Leukopenia is a reduction in white blood cells, whereas neutropenia specifically refers to a reduced absolute neutrophil count (ANC). The usual adult ANC is approximately 1,500–8,000 cells/mm3; an ANC below 1,500 cells/mm3 indicates neutropenia. Because neutropenia increases the risk of infection, patients should promptly report fever, sore throat, or other signs of infection. Therefore, sore throat and fever are the correct answer.Bleeding and bruising are more suggestive of thrombocytopenia. Headache with hypoglycemia, seizures with sleep apnea, and insomnia with irritability are not characteristic warning manifestations of leukopenia or neutropenia. Other important adverse effects of ACE inhibitors include dry cough, hyperkalemia, hypotension, and potentially life-threatening angioedema.
Key Points:
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The risk of ACE inhibitor–associated neutropenia is greater in patients with renal impairment and collagen vascular disease; periodic white blood cell monitoring may be considered in these patients.
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Monitor blood pressure, serum creatinine, and potassium after starting lisinopril and following dosage increases.
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ACE inhibitors can cause fetal harm and should be discontinued as soon as pregnancy is detected.
Exam Pearl: A persistent dry cough with an ACE inhibitor results from bradykinin accumulation and may resolve after switching to an angiotensin receptor blocker.
