QuestionSBA
QuestionChoice
Lisinopril is an angiotensin converting enzyme inhibitor (ACE-I) that is used as a first line antihypertensive for patients with type 2 diabetes mellitus. Dry cough is a common or very common side effect of ACE-I. The mechanism of action is believed to be related to a decrease in degradation and subsequently an increase in buildup of bradykinin. NICE guidance recommends for an angiotensin receptor block (ARB), for example losartan potassium, to be offered if ACE-i is not tolerated
34255
a
Stop lisinopril in exchange for losartan potassium 50 mg PO once daily
QuestionChoice
Sertraline is not known to cause dry cough. Amoxicillin is not required because the dry cough is less likely to be caused by infection in view of the clinical picture described
34259
e
Stop sertraline and commence treatment with amoxicillin 500 mg PO three times daily
QuestionChoice
Sertraline is not known to cause dry cough
34258
d
Stop sertraline in exchange for citalopram 20 mg PO once daily
QuestionChoice
Metformin is not known to cause dry cough
34256
b
Stop metformin hydrochloride in exchange for gliclazide 40 mg PO once daily
QuestionChoice
Captopril is another example of ACE-i and so is unlikely to help with the dry cough
34257
c
Stop lisinopril in exchange for captopril 25 mg PO twice daily
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2794
ACE inhibitor side effects
Topic
92
General Practice
6862
Case presentation: A 60-year-old man visits his GP for medication review. He complains of a recent-onset persistent dry cough but denies having fever or any coryzal symptoms. The cough is not worse when lying down. The patient is not a smoker and the cough only happened after he started on a new prescription.  

PMH: Diabetes Mellitus, Hypertension, Depression
DH: Metformin 500 mg PO TDS, Lisinopril 20 mg PO OD, Sertraline 50 mg PO OD
Observations: Temperature 36.5, Respiratory rate 12, Blood pressure 125/85, Heart rate 78
On Examination: Chest is clear with no added sounds. HS I+II+0.

Question: Select the most appropriate option for the management of the adverse drug reaction.
a