Iloprost

INTRODUCTION

Indications

Management of New York Class III/IV symptoms of pulmonary hypertension, where there is marked limitation of physical activity.

Action

Dilates pulmonary and arterial vasculature. Therapeutic Effects: Improved exercise capacity.

Adverse Reactions/Side Effects

CNS: fainting, headache, insomnia. Resp: ↑ cough, dyspnea, hemoptysis. CV: CHF, vasodilation, chest pain, hypotension, peripheral edema, supraventricular tachycardia. GI: nausea, vomiting. GU: renal failure. Derm: facial flushing. MS: back pain, jaw-muscle spasm, muscle cramps.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

• 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, dyspnea, fainting, and fatigue/weakness.

• Assess blood pressure (BP) periodically, and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fainting, or other symptoms.

• Monitor signs of renal failure, including decreased urine output, increased BP, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

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

• Assess any breathing problems such as increased cough, coughing up blood, or difficult, labored breathing. Report excessive or prolonged respiratory problems to the physician.

• Monitor signs of vasodilation including redness, warmth, flushing, and edema in the face and extremities. Report any problematic vasodilation to the physician.

Interventions

• Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (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 BP.

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

Patient/Client-Related Instruction

• Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged headache, sleep loss, or GI problems (nausea, vomiting).

Pharmacokinetics

Absorption: Unknown.

Distribution: Unknown.

Metabolism and Excretion: Any absorbed iloprost is metabolized.

Half-life: 20–30 min (plasma).