Fenoldopam

INTRODUCTION

Indications

Short-term (<48 hr), in-hospital management of hypertensive emergencies, including malignant hypertension with end-organ deterioration.

Action

Acts as an agonist at dopamine D₁–like receptors. Also binds to alpha-adrenergic receptors. Acts as a vasodilator. Therapeutic Effects: Rapid lowering of blood pressure.

Adverse Reactions/Side Effects

CNS: headache, nervousness/anxiety, dizziness. CV: hypotension, tachycardia, ECG changes, peripheral edema. GI: nausea, abdominal pain, constipation, diarrhea, vomiting. Derm: flushing, sweating. F and E: hypokalemia. Local: injection site reactions. MS: back pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report increased heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• 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 any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor and report any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

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

• Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• After the emergency hypertensive episode has been controlled, design and implement aerobic exercise and endurance training programs to reduce hypertension.

• Because of an increased risk of tachycardia and other cardiac arrhythmias, use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.) or displays other criteria for exercise termination (See Appendix L).

• 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.

Patient/Client-Related Instruction

• Counsel patients about additional interventions to help control blood pressure, 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 headache, nervousness, anxiety, skin reactions (flushing, ...