Pharmacologic: angiotensin II receptor antagonists
Alone or with other agents in the management of hypertension. Treatment of heart failure (New York Heart Association classes II–IV). Reduction of risk of death from cardiovascular causes in patients with left ventricular systolic dysfunction following myocardial infarction.
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 patients with hypertension. Decreased risk of heart-failure–related hospitalizations in patients with heart failure. ↓ risk of death from cardiovascular causes in patients with left ventricular systolic dysfunction following myocardial infarction.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache. CV: hypotension, edema. EENT: rhinitis, sinusitis, pharyngitis. F and E: hyperkalemia. GI: abdominal pain, diarrhea, nausea. GU: impaired renal function. MS: arthralgia, back pain. Misc: ANGIOEDEMA.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician of these signs immediately.
Assess blood pressure periodically and compare to normal values (See Appendix F) to help determine antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.
Assess signs and symptoms of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) to help document whether drug therapy is effective in reducing these symptoms.
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 peripheral vasodilation.
Watch for signs of impaired renal function, including decreased urine output, cloudy urine, or sudden weight gain due to fluid retention. Report these signs to the physician.
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.
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.
Assess any back pain or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.
Implement aerobic exercise and cardiac conditioning programs to augment drug therapy and maintain or improve cardiovascular pump function in patients with heart failure and other cardiac conditions.
Use caution during aerobic exercise and other forms of therapeutic exercise in patients recovering from myocardial infarction. Assess exercise tolerance frequently (blood pressure, heart rate, ...