Therapeutic: antianginals, antihypertensives
Pharmacologic: calcium channel blockers
Management of hypertension, angina pectoris, and vasospastic (Prinzmetal's) angina.
Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Therapeutic Effects: Systemic vasodilation resulting in decreased blood pressure. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina.
Adverse Reactions/Side Effects
CNS: headache, abnormal dreams, anxiety, confusion, dizziness, drowsiness, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea. CV: ARRHYTHMIAS, CHF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia. GI: abnormal liver function studies, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting. GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency. Derm: dermatitis, erythema multiforme, flushing, increased sweating, photosensitivity, pruritus/urticaria, rash. Endo: gynecomastia, hyperglycemia. Hemat: anemia, leukopenia, thrombocytopenia. Metab: weight gain. MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.
Monitor rashes or other skin reactions (hives, abnormal sweating, itching/burning, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).
Assess routinely for signs of CHF and pulmonary edema (dyspnea, cough, shortness of breath, rales/crackles, jugular venous distention). Report these signs to the physician.
Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects.
Assess episodes of angina pectoris at rest and during exercise. Document whether drug therapy is helpful in reducing the frequency and severity of anginal attacks.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles due to peripheral vasodilation.
Assess signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.
Monitor and report signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia. Periodic blood tests may be needed to monitor WBC and RBC counts.
Watch for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Insulin dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.
Assess any joint stiffness or muscle cramping to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.