Nimodipine

INTRODUCTION

Indications

Management of subarachnoid hemorrhage.

Action

Inhibits the transport of calcium into vascular smooth muscle cells, resulting in inhibition of excitationcontraction coupling and subsequent contraction. Potent peripheral vasodilator. Therapeutic Effects: Prevention of vascular spasm after subarachnoid hemorrhage, resulting in decreased neurologic impairment.

Adverse Reactions/Side Effects

CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea. CV: ARRHYTHMIAS, CHF, bradycardia, chest pain, hypotension, palpitations, peripheral edema, syncope, tachycardia. GI: abnormal liver function studies, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting. GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency. Derm: dermatitis, erythema multiforme, flushing, increased sweating, photosensitivity, pruritus/urticaria, rash. Endo: gynecomastia, hyperglycemia. Hemat: anemia, leukopenia, thrombocytopenia. Metab: weight gain. MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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, fainting, and fatigue/weakness.

• Monitor rashes or other skin reactions (hives, abnormal sweating, itching/burning, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).

• Assess routinely for signs of CHF and pulmonary edema (dyspnea, cough, shortness of breath, rales/crackles, jugular venous distention). Report these signs to the physician.

• Assess patient's neurologic status (level of consciousness, sensory and motor function) periodically following administration to help determine benefits in treating subarachnoid hemorrhage. Notify physician of any sudden decline in alertness, cognition, or motor function.

• 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.

• Watch for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Insulin dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

• Monitor and report signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia.

• Assess signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

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

• Assess dizziness and weakness 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 ...