Side Effects - NCLEX-PN
Card 0 of 408
What is the most common vitamin deficiency seen in patients taking metformin?
What is the most common vitamin deficiency seen in patients taking metformin?
B12 deficiency is common in patients on metformin, and should be monitored and supplemented either sublingually or intramuscularly.
B12 deficiency is common in patients on metformin, and should be monitored and supplemented either sublingually or intramuscularly.
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A 63 year old female presents with involuntary grimacing, lip smacking, excessive blinking, and sticking out of the tongue. She also flicks her fingers and her wrists. She states that she has no control over these movements, and that they have gotten progressively worse over the last three years. Her family is worried that she may be experiencing an early form of dementia. Her medical history is significant for depression, for which she has been taking aripiprazole for the last nine years. Which of the following is the most likely cause of her symptoms?
A 63 year old female presents with involuntary grimacing, lip smacking, excessive blinking, and sticking out of the tongue. She also flicks her fingers and her wrists. She states that she has no control over these movements, and that they have gotten progressively worse over the last three years. Her family is worried that she may be experiencing an early form of dementia. Her medical history is significant for depression, for which she has been taking aripiprazole for the last nine years. Which of the following is the most likely cause of her symptoms?
The most likely cause of uncontrollable muscle movements in the absence of other systemic symptoms in a patient with a history of antipsychotic drug use is tardive dyskinesia. This is a disorder of rapid involuntary movements, most often in the face or head but also potentially affecting the extremities. It's exact cause is not well understood, but it is theorized to be an issue of sensitization of the D2 dopamine receptors after long-term neuroleptic use.
The most likely cause of uncontrollable muscle movements in the absence of other systemic symptoms in a patient with a history of antipsychotic drug use is tardive dyskinesia. This is a disorder of rapid involuntary movements, most often in the face or head but also potentially affecting the extremities. It's exact cause is not well understood, but it is theorized to be an issue of sensitization of the D2 dopamine receptors after long-term neuroleptic use.
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Which of the following is not a common side effects in individuals using selective serotonin reuptake inhibitors (SSRI's)?
Which of the following is not a common side effects in individuals using selective serotonin reuptake inhibitors (SSRI's)?
While SSRI's have been known to cause a variety of adverse effects, including diminished libido, increased risk of suicide in children and adolescents, restlessness, photosensitivity, and increased risk of bone fracture, individuals taking SSRI's are not associated with any increased incidence of coronary heart disease.
While SSRI's have been known to cause a variety of adverse effects, including diminished libido, increased risk of suicide in children and adolescents, restlessness, photosensitivity, and increased risk of bone fracture, individuals taking SSRI's are not associated with any increased incidence of coronary heart disease.
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Which of the following over-the-counter medications has been associated with hepatotoxicity and liver failure?
Which of the following over-the-counter medications has been associated with hepatotoxicity and liver failure?
Acetaminophen has surpassed viral hepatitis as the most common cause of acute hepatic failure in the United States. Hepatotoxicity can occur in doses of 7.5g or up for adults and 150millg/kg of body weight in children aged 1-6. None of the other drugs listed are particularly hepatotoxic.
Acetaminophen has surpassed viral hepatitis as the most common cause of acute hepatic failure in the United States. Hepatotoxicity can occur in doses of 7.5g or up for adults and 150millg/kg of body weight in children aged 1-6. None of the other drugs listed are particularly hepatotoxic.
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What is the mechanism of cytotoxicity in acetaminophen-related liver failure?
What is the mechanism of cytotoxicity in acetaminophen-related liver failure?
Acetaminophen depletes glutathione, one of the body's most important antioxidants. The liver is the body's main processing organ for environmental and ingested toxins, and glutathione is the primary molecule the liver uses to rid itself of the harmful biproducts of the detoxification process. When glutathione is severely depleted, such as with acetaminophen overdose, hepatic cells can rapidly necrose, resulting in liver failure and even death.
Acetaminophen depletes glutathione, one of the body's most important antioxidants. The liver is the body's main processing organ for environmental and ingested toxins, and glutathione is the primary molecule the liver uses to rid itself of the harmful biproducts of the detoxification process. When glutathione is severely depleted, such as with acetaminophen overdose, hepatic cells can rapidly necrose, resulting in liver failure and even death.
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An individual taking which of the following medications must be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis?
An individual taking which of the following medications must be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis?
Alendronate is a bisphosphonate drug used in the treatment of osteoporosis and osteogenesis imperfecta. An individual taking this medication should be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis. Other gastrointestinal adverse effects of alendronate include esophageal strictures, achalasia, gastric ulcers, and gastritis. None of the other medications listed are associated with esophagitis.
Alendronate is a bisphosphonate drug used in the treatment of osteoporosis and osteogenesis imperfecta. An individual taking this medication should be instructed to remain upright for a minimum of thirty minutes after ingestion in order to avoid esophagitis. Other gastrointestinal adverse effects of alendronate include esophageal strictures, achalasia, gastric ulcers, and gastritis. None of the other medications listed are associated with esophagitis.
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Which of the following is not as side effect associated with beta blockers?
Which of the following is not as side effect associated with beta blockers?
The most common side effects of beta blockers are fatigue, dizziness, weakness, cold hands or feet, dry mouth, headache, nausea, diarrhea, and shortness of breath.
The most common side effects of beta blockers are fatigue, dizziness, weakness, cold hands or feet, dry mouth, headache, nausea, diarrhea, and shortness of breath.
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Which of the following medications is associated with increased risk of SIADH (syndrome of inappropriate antidiuretic hormone secretion)?
Which of the following medications is associated with increased risk of SIADH (syndrome of inappropriate antidiuretic hormone secretion)?
Chlorpropamide, an antidiabetic medication in the sulfonylurea class, has been associated with drug-induced SIADH (syndrome of inappropriate antidiuretic hormone secretion). This is a rare but serious complication that will generally resolve once drug treatment has stopped. None of the other drugs listed are associated with this side effect.
Chlorpropamide, an antidiabetic medication in the sulfonylurea class, has been associated with drug-induced SIADH (syndrome of inappropriate antidiuretic hormone secretion). This is a rare but serious complication that will generally resolve once drug treatment has stopped. None of the other drugs listed are associated with this side effect.
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Death by opiate overdose is generally the result of __________.
Death by opiate overdose is generally the result of __________.
Most opiates can cause respiratory depression when taken in toxic levels. They do this by reducing the sensitivity of respiratory center neurons to carbon dioxide, which results in decreased breathing. In more moderate cases brain damage can precede death due to CNS hypoxia. Opiates generally are not associated with liver failure (unless taken as a combination drug with acetaminophen, such as hydrocodone), heart attack, or serotonin syndrome.
Most opiates can cause respiratory depression when taken in toxic levels. They do this by reducing the sensitivity of respiratory center neurons to carbon dioxide, which results in decreased breathing. In more moderate cases brain damage can precede death due to CNS hypoxia. Opiates generally are not associated with liver failure (unless taken as a combination drug with acetaminophen, such as hydrocodone), heart attack, or serotonin syndrome.
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A nurse is working with a 36 year old patient comes in for a back injury after a motor vehicle accident. He is prescribed oxycodone-acetaminophen for pain relief. Three days later he calls the nurse to complain that he is experiencing itching all over. He is concerned that he might be having an allergic reaction to the pain medication. There is no rash associated with his pruritus. He has no hives, no nausea or vomiting, no shortness of breath, no swelling of the mouth or face. What is the most likely cause of his itching?
A nurse is working with a 36 year old patient comes in for a back injury after a motor vehicle accident. He is prescribed oxycodone-acetaminophen for pain relief. Three days later he calls the nurse to complain that he is experiencing itching all over. He is concerned that he might be having an allergic reaction to the pain medication. There is no rash associated with his pruritus. He has no hives, no nausea or vomiting, no shortness of breath, no swelling of the mouth or face. What is the most likely cause of his itching?
Many opiates stimulate histamine release by mast cells. The cause of this stimulation remains unclear, but it is considered to be a non-immunological (therefore, not an allergy). There is some speculation that opiates trigger the release of histamine from mast cells by directly activating G proteins on mast cell surfaces. Opiates are not generally associated with kidney failure, and the most common symptoms in opiate allergy include hives, flushing, hives, low blood pressure, gastrointestinal discomfort (though constipation is typical in most patients and does not indicate allergic reaction), and angioedema.
Many opiates stimulate histamine release by mast cells. The cause of this stimulation remains unclear, but it is considered to be a non-immunological (therefore, not an allergy). There is some speculation that opiates trigger the release of histamine from mast cells by directly activating G proteins on mast cell surfaces. Opiates are not generally associated with kidney failure, and the most common symptoms in opiate allergy include hives, flushing, hives, low blood pressure, gastrointestinal discomfort (though constipation is typical in most patients and does not indicate allergic reaction), and angioedema.
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Which of the following is a common side effect of non-steroidal anti-inflammatory (NSAID) use?
Which of the following is a common side effect of non-steroidal anti-inflammatory (NSAID) use?
NSAID's are frequently associated with irritation of the gastric mucosa. This can lead to gastritis, ulcer formation, gastric bleeding, or perforation. NSAID use is not generally associated with weight gain, loss of bone density, muscle spasms, or hypertension.
NSAID's are frequently associated with irritation of the gastric mucosa. This can lead to gastritis, ulcer formation, gastric bleeding, or perforation. NSAID use is not generally associated with weight gain, loss of bone density, muscle spasms, or hypertension.
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Which of the following medications can cause the (benign) side effect of causing an orange-red tint to urine and tears?
Which of the following medications can cause the (benign) side effect of causing an orange-red tint to urine and tears?
Of the drugs listed, the only one associated with this bizarre side effect is rifampicin, a broad spectrum antibiotic used in tuberculosis. Urine, sweat, saliva, or tears may be turned any shade from red to reddish orange.
Of the drugs listed, the only one associated with this bizarre side effect is rifampicin, a broad spectrum antibiotic used in tuberculosis. Urine, sweat, saliva, or tears may be turned any shade from red to reddish orange.
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Which of the following antibiotics is potentially ototoxic and may cause irreversible hearing loss?
Which of the following antibiotics is potentially ototoxic and may cause irreversible hearing loss?
Gentamicin is an aminoglycoside antibiotic. Most antibiotics in the aminoglycoside class can have significant ototoxic effects. Of these, streptomycin and gentamicin are primarily toxic to the vestubular system, while amikacin, neomycin, dihydrosterptomycin, and kanamicin primarily affect the cochlea. None of the other antibiotics listed are generally associated with ototoxicity.
Gentamicin is an aminoglycoside antibiotic. Most antibiotics in the aminoglycoside class can have significant ototoxic effects. Of these, streptomycin and gentamicin are primarily toxic to the vestubular system, while amikacin, neomycin, dihydrosterptomycin, and kanamicin primarily affect the cochlea. None of the other antibiotics listed are generally associated with ototoxicity.
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A 24 year old female presents with a simple urinary tract infection, for which she is prescribed ciprofloxacin. What is the most severe potential side effect of this medication?
A 24 year old female presents with a simple urinary tract infection, for which she is prescribed ciprofloxacin. What is the most severe potential side effect of this medication?
Ciprofloxacin has been associated with several cases of tendon injury and rupture, with the typical rupture occuring in the Achilles tendon. Other less severe side effects can include nausea and vomiting, headache, insomnia, and increased sensitivity to caffeine. The other symptoms listed are not generally associated with ciprofloxacin use.
Ciprofloxacin has been associated with several cases of tendon injury and rupture, with the typical rupture occuring in the Achilles tendon. Other less severe side effects can include nausea and vomiting, headache, insomnia, and increased sensitivity to caffeine. The other symptoms listed are not generally associated with ciprofloxacin use.
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Which of the following antibiotics is strictly contraindicated in pregnancy, in lactating mothers, or in children under 8 years old, due to risk of irreversible teeth staining?
Which of the following antibiotics is strictly contraindicated in pregnancy, in lactating mothers, or in children under 8 years old, due to risk of irreversible teeth staining?
Tetracycline antibiotics are strictly contraindicated in pregnancy, in lactating mothers, or in children under 8 years old, due to risk of irreversible teeth staining. The discoloration occurs only in adult teeth that have not broken the gum-line, so adults are not at risk.
Tetracycline antibiotics are strictly contraindicated in pregnancy, in lactating mothers, or in children under 8 years old, due to risk of irreversible teeth staining. The discoloration occurs only in adult teeth that have not broken the gum-line, so adults are not at risk.
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You are assessing a 23-year old female who presents for follow-up after being started on oral iron sulfate one month ago for iron-deficiency anemia. In the last month she was also started on azithromycin for a respiratory infection, and has been taking ibuprofen for back pain. She now complains of three weeks of constipation. She tells you that her diet consists of many green, leafy vegetables, red meat, and greasy, fatty foods. Which of the following is the most likely cause of her constipation?
You are assessing a 23-year old female who presents for follow-up after being started on oral iron sulfate one month ago for iron-deficiency anemia. In the last month she was also started on azithromycin for a respiratory infection, and has been taking ibuprofen for back pain. She now complains of three weeks of constipation. She tells you that her diet consists of many green, leafy vegetables, red meat, and greasy, fatty foods. Which of the following is the most likely cause of her constipation?
The most likely cause of this patient's constipation is the oral iron sulfate that she is taking. Constipation is a very common side effect of oral iron therapy, and for that reason, iron therapy is often given concurrently with a stool softener to relieve constipation.
The other medications taken, azithromycin, and ibuprofen, each commonly cause some degree of gastrointestinal upset, including but not limited to abdominal pain and diarrhea, but not constipation.
Dietarily, the consumption of green, leafy vegetables is associated with looser, more regular bowel movements, as opposed to constipation. The consumption of greasy, fatty foods is also associated with looser bowel movements, rather than constipation, making it unlikely that her diet is the cause of her constipation.
The most likely cause of this patient's constipation is the oral iron sulfate that she is taking. Constipation is a very common side effect of oral iron therapy, and for that reason, iron therapy is often given concurrently with a stool softener to relieve constipation.
The other medications taken, azithromycin, and ibuprofen, each commonly cause some degree of gastrointestinal upset, including but not limited to abdominal pain and diarrhea, but not constipation.
Dietarily, the consumption of green, leafy vegetables is associated with looser, more regular bowel movements, as opposed to constipation. The consumption of greasy, fatty foods is also associated with looser bowel movements, rather than constipation, making it unlikely that her diet is the cause of her constipation.
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You are the nurse taking care of a patient with a history of schizophrenia, not on any medications, who is being admitted for disorganized thoughts, paranoid delusions, auditory hallucinations, and combative behavior. The physician orders a dose of haloperidol to be administered. Prior to giving the haloperidol, you suggest that which of the following be done?
You are the nurse taking care of a patient with a history of schizophrenia, not on any medications, who is being admitted for disorganized thoughts, paranoid delusions, auditory hallucinations, and combative behavior. The physician orders a dose of haloperidol to be administered. Prior to giving the haloperidol, you suggest that which of the following be done?
The correct answer is "Obtain an electrocardiogram (ECG)."
This question tests your knowledge of the major side effects of the first-generation anti-psychotic medication, haloperidol, also known as Haldol. Some of the major side effects of haloperidol include extrapyramidal symptoms, anticholinergic symptoms, blood pressure changes, and hypersomnolence.
In addition, haloperidol has the potential to prolong the QTc interval on an ECG. QTc prolongation can be particularly dangerous in patients who already have a prolonged QTc interval due to a pre-existing medical condition (e.g. Long QT Syndrome), or medications they are already taking. A prolonged QTc interval has the potential to progress on ECG to more dangerous arrhythmias including torsades de pointes and ventricular fibrillation/tachycardia, which can be fatal. Therefore, it is imperative to check a patient's QTc interval on an ECG prior to administering haloperidol to confirm that they do not already have a prolonged QTc interval.
While this patient's blood glucose is not necessarily going to be normal, that is not something that needs to be emergently checked prior to haloperidol administration.
There is no indication to obtain a chest x-ray or CT abdomen prior to haloperidol administration.
It would be inappropriate to contact the authorities to detain this acutely psychotic patient with schizophrenia, as the patient is already in the hospital and in the care of a psychiatric medical team. Further, even though the patient is combative, if necessary, the medical team is allowed to place the patient in restraints without the need for police intervention. There is no evidence that any members of the care team are in acute danger.
The correct answer is "Obtain an electrocardiogram (ECG)."
This question tests your knowledge of the major side effects of the first-generation anti-psychotic medication, haloperidol, also known as Haldol. Some of the major side effects of haloperidol include extrapyramidal symptoms, anticholinergic symptoms, blood pressure changes, and hypersomnolence.
In addition, haloperidol has the potential to prolong the QTc interval on an ECG. QTc prolongation can be particularly dangerous in patients who already have a prolonged QTc interval due to a pre-existing medical condition (e.g. Long QT Syndrome), or medications they are already taking. A prolonged QTc interval has the potential to progress on ECG to more dangerous arrhythmias including torsades de pointes and ventricular fibrillation/tachycardia, which can be fatal. Therefore, it is imperative to check a patient's QTc interval on an ECG prior to administering haloperidol to confirm that they do not already have a prolonged QTc interval.
While this patient's blood glucose is not necessarily going to be normal, that is not something that needs to be emergently checked prior to haloperidol administration.
There is no indication to obtain a chest x-ray or CT abdomen prior to haloperidol administration.
It would be inappropriate to contact the authorities to detain this acutely psychotic patient with schizophrenia, as the patient is already in the hospital and in the care of a psychiatric medical team. Further, even though the patient is combative, if necessary, the medical team is allowed to place the patient in restraints without the need for police intervention. There is no evidence that any members of the care team are in acute danger.
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A physician orders Viagra (sildenafil) for a patient to treat erectile dysfunction. The patient currently takes fish oil, nitrates for chest pain, prednisone for lupus, and aspirin and simvastatin for vascular disease. Sildenafil is contraindicated in this patient because he takes which medication?
A physician orders Viagra (sildenafil) for a patient to treat erectile dysfunction. The patient currently takes fish oil, nitrates for chest pain, prednisone for lupus, and aspirin and simvastatin for vascular disease. Sildenafil is contraindicated in this patient because he takes which medication?
The correct answer is nitrates.
Sildenafil is contraindicated in a patient who is already taking nitrates because nitrates alone can cause a decrease in the patient's blood pressure, and sildenafil can also independently cause a decrease in the patient's blood pressure. When taken together, sildenafil and nitrates can cause a potentially very serious drop in the patient's blood pressure than can cause headache, dizziness, weakness, syncope, and any further consequences of those symptoms. Thus, whenever sildenafil is being considered for a patient, their current medication list should be closely evaluated for any other medications that may decrease their blood pressure.
Neither fish oil, simvastatin, prednisone, nor aspirin are known to decrease blood pressure and therefore would not be contraindications for administering sildenafil to this patient.
The correct answer is nitrates.
Sildenafil is contraindicated in a patient who is already taking nitrates because nitrates alone can cause a decrease in the patient's blood pressure, and sildenafil can also independently cause a decrease in the patient's blood pressure. When taken together, sildenafil and nitrates can cause a potentially very serious drop in the patient's blood pressure than can cause headache, dizziness, weakness, syncope, and any further consequences of those symptoms. Thus, whenever sildenafil is being considered for a patient, their current medication list should be closely evaluated for any other medications that may decrease their blood pressure.
Neither fish oil, simvastatin, prednisone, nor aspirin are known to decrease blood pressure and therefore would not be contraindications for administering sildenafil to this patient.
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You are the nurse taking care of a patient who takes multi-vitamins, pravastatin, verapamil, warfarin, and prednisone daily, as well as sildenafil as needed for erectile dysfunction. He complains of headaches and dizziness when he takes the sildenafil. What is the most likely reason for these complaints?
You are the nurse taking care of a patient who takes multi-vitamins, pravastatin, verapamil, warfarin, and prednisone daily, as well as sildenafil as needed for erectile dysfunction. He complains of headaches and dizziness when he takes the sildenafil. What is the most likely reason for these complaints?
The correct answer is "The combined actions of verapamil and sildenafil."
This question tests your understanding of the side effects of multiple medications, as well as how they may interact with one another. In this patient, he complains of headaches and dizziness that are brought on by taking sildenafil, an erectile dysfunction medication. Common side effects of sildenafil include headaches and lightheadedness, as sildenafil can decrease systemic blood pressure since it is a vasodilator.
The risk of experiencing these side effects from sildenafil is increased in patients who take other medications that can decrease blood pressure. Of the other medications that this patient takes, verapamil, a calcium-channel blocker, is the most likely medication that is known to decrease blood pressure. The combined actions of sildenafil and verapamil (both to decrease blood pressure) best explain the headaches and dizziness that this patient experiences when taking sildenafil in addition to his daily verapamil.
None of the other choices are correct, as the only choice that contained two medications that each individually would decrease blood pressure to explain the patient's symptoms was the choice containing verapamil and sildenafil.
The correct answer is "The combined actions of verapamil and sildenafil."
This question tests your understanding of the side effects of multiple medications, as well as how they may interact with one another. In this patient, he complains of headaches and dizziness that are brought on by taking sildenafil, an erectile dysfunction medication. Common side effects of sildenafil include headaches and lightheadedness, as sildenafil can decrease systemic blood pressure since it is a vasodilator.
The risk of experiencing these side effects from sildenafil is increased in patients who take other medications that can decrease blood pressure. Of the other medications that this patient takes, verapamil, a calcium-channel blocker, is the most likely medication that is known to decrease blood pressure. The combined actions of sildenafil and verapamil (both to decrease blood pressure) best explain the headaches and dizziness that this patient experiences when taking sildenafil in addition to his daily verapamil.
None of the other choices are correct, as the only choice that contained two medications that each individually would decrease blood pressure to explain the patient's symptoms was the choice containing verapamil and sildenafil.
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You are counseling a patient about the possible side effects of his new blood pressure medication, lisinopril, which is an ACE inhibitor. Which of the following statements would be most appropriate to make when counseling the patient?
You are counseling a patient about the possible side effects of his new blood pressure medication, lisinopril, which is an ACE inhibitor. Which of the following statements would be most appropriate to make when counseling the patient?
The correct answer is "You may experience a barky cough when taking lisinopril."
This question tests your knowledge of the side effect profile of lisinopril. A very common side effect associated with lisinopril use is a barky cough. Lisinopril, an ACE inhibitor, has an additional effect of inhibiting the degradation of bradykinin, therefore raising circulating levels of bradykinin. Elevated levels of bradykinin result in bronchoconstriction, which can cause the dry, barky cough that some patients taking lisinopril experience.
Other side effects of lisinopril include but are not limited to hypotension, headache, dizziness, and syncope.
Lisinopril is not known to cause an elevated risk of renal cell carcinoma, myocardial infarction, stroke, or blindness.
The correct answer is "You may experience a barky cough when taking lisinopril."
This question tests your knowledge of the side effect profile of lisinopril. A very common side effect associated with lisinopril use is a barky cough. Lisinopril, an ACE inhibitor, has an additional effect of inhibiting the degradation of bradykinin, therefore raising circulating levels of bradykinin. Elevated levels of bradykinin result in bronchoconstriction, which can cause the dry, barky cough that some patients taking lisinopril experience.
Other side effects of lisinopril include but are not limited to hypotension, headache, dizziness, and syncope.
Lisinopril is not known to cause an elevated risk of renal cell carcinoma, myocardial infarction, stroke, or blindness.
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