Telmisartan

INTRODUCTION

Indications

Alone or with other agents in the management of 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 hypertensive patients.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache. CV: hypotension. EENT: sinusitis. F and E: hyperkalemia. GI: abdominal pain, diarrhea, dyspepsia. GU: impaired renal function. MS: back pain, myalgia. 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. Report these signs to the physician immediately.

• Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects.

• 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 and report signs of impaired renal function, including decreased urine output, cloudy urine, or sudden weight gain due to fluid retention.

• Assess any muscle pain or back pain 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 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

• 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

• 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, nasal inflammation, or GI problems (diarrhea, indigestion, abdominal pain).

Pharmacokinetics

Absorption: 42–58% absorbed following oral administration (bioavailability increased in patients with hepatic impairment).

Distribution: Crosses the placenta.

Protein Binding: 99.5%.

Metabolism and Excretion: Excreted mostly unchanged in feces via biliary excretion.

Half-life: 24 hr.