Eplerenone

INTRODUCTION

Indications

Hypertension (alone or with other agents). LV systolic dysfunction and evidence of HF post-MI.

Action

Blocks the effects of aldosterone by attaching to mineralocorticoid receptors. Therapeutic Effects: Lowering of blood pressure. Improves survival in patients with evidence of HF post-MI.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue. GI: abnormal liver function tests, abdominal pain, diarrhea. GU: albuminuria. Endo: abnormal vaginal bleeding, gynecomastia. F and E: HYPERKALEMIA. Metab: hypercholesterolemia, hypertriglyceridemia. Misc: flu-like symptoms.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Notify physician because severe cases can lead to life-threatening arrhythmias and paralysis.

• Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects.

• Assess dizziness and fatigue that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Implement fall prevention strategies, especially in older adults or if patient exhibits sedation, dizziness, clumsiness, or other impairments that affect gait and balance (See Appendix E).

• Use caution during aerobic exercise, especially after recent MI or in hot environments. Increased sweating will cause fluid and electrolyte loss and may exaggerate arrhythmias and diuretic side effects (dizziness, muscle cramps, and so forth).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control hypertension and other cardiac conditions even if they are asymptomatic.

• Counsel patients about additional interventions to help control blood pressure and cardiac dysfunction, such as regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.

• Advise patient that this drug may cause problems in fat metabolism, including hypercholesterolemia and hypertriglyceridemia. Remind patient that periodic blood tests may be needed to monitor plasma lipids.

• Instruct patient or family and caregivers to report other troublesome side effects such as severe flu-like symptoms, breast growth in men (gynecomastia), abnormal vaginal bleeding, or GI problems (diarrhea, abdominal pain).

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Unknown.

Metabolism and Excretion: Mostly metabolized by the liver (CYP3A4 enzyme system); <5% excreted unchanged by the kidneys.

Half-life: 4–6 hr.

Contraindications/Precautions