Hydralazine

INTRODUCTION

Indications

Moderate to severe hypertension (with a diuretic). Unlabeled Use: CHF unresponsive to conventional therapy with digoxin and diuretics.

Action

Direct-acting peripheral arteriolar vasodilator. Therapeutic Effects: Lowering of blood pressure in hypertensive patients and decreased afterload in patients with CHF.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, headache. CV: tachycardia, angina, arrhythmias, edema, orthostatic hypotension. GI: diarrhea, nausea, vomiting. Derm: rashes. F and E: sodium retention. MS: arthralgias, arthritis. Neuro: peripheral neuropathy. Misc: drug-induced lupus syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Assess signs and symptoms of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) to help document whether drug therapy is effective in reducing these symptoms.

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

• Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to sodium and fluid retention.

• Assess numbness, tingling, or weakness that might indicate peripheral neuropathy. Establish baseline electroneuromyographic values using EMG and nerve conduction whenever possible. Periodically reexamine these values to document drug-induced changes in peripheral nerve function.

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

• Assess dizziness and drowsiness 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.

• Monitor signs of drug-induced lupus syndrome, including increased BP, fever, joint pain, skin rashes, and redness/irritation of the eye (uveitis). Notify physician promptly if these signs appear.

Interventions

• Design and implement aerobic exercise and endurance training programs to reduce hypertension, and improve myocardial pumping ability.

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

• Avoid physical therapy interventions that ...