minoxidil (systemic) (mi-nox-i-dil)
Severe symptomatic hypertension or hypertension associated with end-organ damage that has failed to respond to combinations of more conventional therapy.
Directly relaxes vascular smooth muscle, probably by inhibiting the enzyme phosphodiesterase. Results in vasodilation, which is more pronounced in arterioles than veins. Therapeutic Effects: Lowering of blood pressure.
Adverse Reactions/Side Effects
CNS: headache. Resp: PULMONARY EDEMA. CV: CHF, ECG changes (alteration in T waves), tachycardia, angina, pericardial effusion. GI: nausea. Derm: hypertrichosis, pigment changes, rashes. Endo: gynecomastia, menstrual irregularities. F and E: sodium and water retention. Misc: intermittent claudication.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Watch for signs of CHF and pulmonary edema, including dyspnea, cough, shortness of breath, rales/crackles, exercise intolerance, and jugular venous distention. Report these signs to the physician immediately.
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 Appendces G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.
Monitor signs of intermittent claudication, including pain, cramping, and fatigue in the lower extremities that occurs when walking. Report severe symptoms or signs of claudication that fail to subside when at rest.
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 water retention.
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 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.
Remind patients to take medication as directed to control hypertension even if they are asymptomatic.
Counsel patients about additional interventions to help control blood pressure, including 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, nausea, excessive hair growth, breast enlargement in men, menstrual irregularities in women, or ...