Pharmacologic: angiotensin II receptor antagonists
Alone or with other agents in the management of hypertension.
Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II at various receptor sites, including vascular smooth muscle and the adrenal glands. Therapeutic Effects: Lowering of blood pressure in patients with hypertension.
Adverse Reactions/Side Effects
CNS: depression, fatigue. CV: hypotension. EENT: pharyngitis, rhinitis. F and E: hyperkalemia. GI: abdominal pain. GU: impaired renal function. MS: pain. Misc: ANGIOEDEMA.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Watch for signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician immediately if these signs occur.
Assess blood pressure periodically and compare to normal values (See Appendix F) to help determine antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.
Watch for signs of impaired kidney function, including hematuria, increased urinary frequency, cloudy urine, decreased urine output, and sudden weight gain due to fluid retention. Report these signs to the physician immediately.
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 any back pain or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Implement aerobic exercise and cardiac-conditioning programs to augment drug therapy and maintain or improve cardiovascular pump function in patients with hypertension and other cardiac conditions.
Avoid physical therapy interventions that cause systemic vasodilation (large whirlpool, Hubbard tank). Additive effects of this drug and the intervention may cause a dangerous fall in blood pressure.
To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.
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.
Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged fatigue, depression, upper respiratory irritation, or abdominal pain.
Absorption: 13% absorbed following oral administration.
Distribution: Crosses the placenta.
Metabolism and Excretion: Excreted mostly unchanged in feces via biliary excretion.