Home Drug Guide Ramipril

Drug Guide

Generic Name

Ramipril

Brand Names Altace

Classification

Therapeutic: Antihypertensive, Heart Failure

Pharmacological: ACE inhibitor (Angiotensin-Converting Enzyme inhibitor)

FDA Approved Indications

  • Hypertension
  • Heart failure post-myocardial infarction
  • Reduce risk of cardiovascular events in patients at high risk

Mechanism of Action

Ramipril inhibits the angiotensin-converting enzyme (ACE), which decreases the production of angiotensin II, leading to vasodilation, reduced blood pressure, and decreased workload on the heart.

Dosage and Administration

Adult: Typically 2.5 mg once daily, titrated up to a maximum of 20 mg once daily based on response.

Pediatric: Not commonly used in children; consult specific guidelines.

Geriatric: Start at lower dose due to increased risk of hypotension and renal impairment.

Renal Impairment: Use with caution; dose adjustment may be necessary based on renal function.

Hepatic Impairment: Adjust dose cautiously; use lower initial doses.

Pharmacokinetics

Absorption: Rapidly absorbed from the gastrointestinal tract.

Distribution: Widely distributed; protein binding ~65%.

Metabolism: Primarily inactive; some metabolism to related compounds.

Excretion: Excreted mainly via the kidneys.

Half Life: Approximately 13-17 hours, allowing for once-daily dosing.

Contraindications

  • History of angioedema related to previous ACE inhibitor therapy
  • Bilateral renal artery stenosis
  • Hypersensitivity to ramipril or other ACE inhibitors

Precautions

  • Pregnancy (category D), lactation, renal impairment, volume depletion, hyperkalemia

Adverse Reactions - Common

  • Cough (Common)
  • Dizziness, headache (Common)
  • Fatigue (Less common)

Adverse Reactions - Serious

  • Angioedema (Rare)
  • Hypotension (Less common)
  • Elevated serum potassium (hyperkalemia) (Less common)
  • Acute renal failure (Rare)

Drug-Drug Interactions

  • Diuretics, especially potassium-sparing (e.g., spironolactone)
  • Other antihypertensives
  • Lithium
  • NSAIDs

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function, and serum electrolytes regularly.

Diagnoses:

  • Risk for hypotension
  • Electrolyte imbalance
  • Impaired renal function

Implementation: Administer as prescribed, observe for signs of angioedema or hypotension.

Evaluation: Assess blood pressure response and laboratory parameters to ensure safety and efficacy.

Patient/Family Teaching

  • Notify healthcare provider if swelling of face, lips, or tongue occurs.
  • Report any signs of hyperkalemia (muscle weakness, irregular heartbeat).
  • Avoid potassium supplements or potassium-sparing diuretics unless directed by a healthcare provider.
  • Do not discontinue abruptly to avoid rebound hypertension.

Special Considerations

Black Box Warnings:

  • Pregnancy: can cause fetal injury and death; discontinue as soon as pregnancy is detected.

Genetic Factors: Genetic polymorphisms may affect drug metabolism and response.

Lab Test Interference: May elevate Serum Potassium and BUN/Creatinine levels; monitor as needed.

Overdose Management

Signs/Symptoms: Severe hypotension, dizziness, syncope.

Treatment: Administer IV fluids as needed; use vasopressors if hypotension persists; consider activated charcoal if ingestion is recent.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended conditions for the duration of the shelf life.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.