Pharmacologic: peripherally acting antiadrenergics
Used in combination with other antihypertensives in the management of hypertension.
Depletes stores of norepinephrine and inhibits uptake in postganglionic adrenergic nerve endings. Therapeutic Effects: Lowering of blood pressure.
Adverse Reactions/Side Effects
CNS: depression, drowsiness, lethargy, anxiety, headache, nervousness, nightmares. EENT: nasal stuffiness, blurred vision, conjunctival congestion, miosis. CV: bradycardia, angina, arrhythmias, edema. GI: diarrhea, cramps, dry mouth, GI bleeding, nausea, vomiting. GU: erectile dysfunction. Derm: flushing. Endo: galactorrhea, gynecomastia. F and E: sodium and water retention.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess blood pressure periodically and compare to normal values (See Appendix F). Document whether drug therapy is successful in controlling hypertension.
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.
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 against falls and trauma.
Be alert for signs of depression, anxiety, lethargy, nervousness, or other changes in mood and behavior. Notify physician if these changes become problematic.
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.
Because of the risk of arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, 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 blood pressure.
To minimize orthostatic hypotension, advise patient to 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, such as regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.
Instruct patient or family/caregivers to report other bothersome side effects such as severe or prolonged headache, drowsiness, nightmares, vision disturbances, nasal congestion, skin flushing, sexual dysfunction, nipple discharge, breast enlargement in men (gynecomastia), or GI problems (diarrhea, nausea, vomiting, cramps, dry mouth, GI bleeding).