Irbesartan

INTRODUCTION

Indications

Alone or with other agents in the management of hypertension. Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension.

Action

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. Decreased progression of diabetic nephropathy.

Adverse Reactions/Side Effects

CNS: anxiety, dizziness, fatigue, headache. CV: chest pain, edema, hypotension, tachycardia. Derm: rashes. GI: abdominal pain, diarrhea, dyspepsia, nausea, vomiting. GU: impaired renal function. F and E: hyperkalemia. 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 of these signs.

• Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• 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 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 vasodilation or fluid retention.

• If treating diabetic neuropathy, establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible. Periodically reexamine these values to monitor peripheral nerve function and document whether drug therapy delays the progression of neuropathic disease.

• Assess any muscle 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.

• 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.

• Watch for signs of impaired renal function, including decreased urine output, cloudy urine, or sudden weight gain due to fluid retention. Report these signs to the physician.

• Assess dizziness 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.

Interventions

• Because of an increased risk of cardiac arrhythmias (tachycardia), 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...