Nisoldipine

INTRODUCTION

Indications

Management of hypertension.

Action

Inhibits the transport of calcium into vascular smooth muscle cells, resulting in inhibition of vasoconstriction and dilation of arterioles. Therapeutic Effects: Systemic vasodilation, resulting in decreased blood pressure.

Adverse Reactions/Side Effects

CNS: headache, dizziness. EENT: pharyngitis, sinusitis. CV: peripheral edema, chest pain, hypotension, palpitations. GI: nausea. Derm: rash. Endo: gynecomastia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Report an excessive fall in blood pressure (hypotension), especially if patient experiences dizziness, fatigue, palpitations, or other symptoms.

• 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.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Because of potential cardiovascular problem (hypotension, palpitations), use caution during aerobic exercise and other therapeutic exercise. 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.

Patient/Client-Related Instruction

• 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, skin rash, nausea, nasal/sinus irritation, and breast enlargement in men (gynecomastia).

Pharmacokinetics

Absorption: Well absorbed (87%) following oral administration but rapidly and extensively metabolized in the gut wall, resulting in 5% bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Highly metabolized CYP3A4 enzyme system.

Half-life: 7–12 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity with calcium channel blockers may occur; Concurrent phenytoin use.

Use Cautiously in: CHF/left ventricular dysfunction; Hepatic impairment (dose reduction may be necessary); Geri: Dose ↓ may be ...