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Canadian Pharmacist Qualifying Exam Practice · Question

A 56-year-old male presents a new prescription for 'ramipril 5 mg PO daily'. His current medications include hydrochlorothiazide 25 mg PO daily, amlodipine 5 mg PO daily, metformin 1000 mg PO BID, and atorvastatin 40 mg PO nightly. He has a reported allergy to 'lisinopril - causes persistent cough'. His blood pressure today is 142/88 mmHg. What is the most appropriate action for the pharmacist to take?

Patients with a history of angioedema or persistent cough with one ACE inhibitor should generally avoid other ACE inhibitors due to the high risk of cross-react

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Question: A 56-year-old male presents a new prescription for 'ramipril 5 mg PO daily'. His current medications include hydrochlorothiazide 25 mg PO daily, amlodipine 5 mg PO daily, metformin 1000 mg PO BID, and atorvastatin 40 mg PO nightly. He has a reported allergy to 'lisinopril - causes persistent cough'. His blood pressure today is 142/88 mmHg. What is the most appropriate action for the pharmacist to take?

Answer options: ✅ Contact the prescriber to discuss an alternative antihypertensive agent due to potential cross-reactivity with ramipril.

  • Dispense ramipril 5 mg PO daily as prescribed, as ramipril causes less cough than lisinopril.
  • Dispense ramipril 2.5 mg PO daily and advise the patient to monitor for cough, then titrate up if tolerated.
  • Advise the patient to stop hydrochlorothiazide as ramipril will provide sufficient blood pressure control.

Correct answer: Contact the prescriber to discuss an alternative antihypertensive agent due to potential cross-reactivity with ramipril.

Explanation: Patients with a history of angioedema or persistent cough with one ACE inhibitor should generally avoid other ACE inhibitors due to the high risk of cross-reactivity. An ARB or another class of antihypertensive would be a safer alternative in this patient.

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