Pharmacologic: ACE inhibitors
Alone or with other agents in the management of hypertension. Management of heart failure. Reduction of risk of death, heart failure–related hospitalizations, and development of overt heart failure following myocardial infarction. Treatment of diabetic nephropathy in patients with type 1 diabetes mellitus and retinopathy.
Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation. Therapeutic Effects: Lowering of blood pressure in patients with hypertension. Improved survival and reduced symptoms in patients with heart failure. Improved survival and reduced development of overt heart failure after myocardial infarction. Decreased progression of diabetic nephropathy with decreased need for transplantation or dialysis.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache, insomnia. Resp: cough, CV: hypotension, chest pain, palpitations, tachycardia. GI: taste disturbances, abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting. GU: proteinuria, impaired renal function. Derm: ANGIOEDEMA, rashes, pruritus. F and E: hyperkalemia. Hemat: AGRANULOCYTOSIS, neutropenia. Misc: fever.
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. Notify physician immediately of these signs.
Monitor signs of agranulocytosis and neutropenia (fever, sore throat, mucosal lesions, signs of infection, bruising). Report these signs to the physician 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, fatigue, 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 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 discomfort, shortness of breath, fainting, and fatigue/weakness.
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.
If treating diabetic neuropathy, establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible. Periodically reexamine these values to document progress and potential improvement in peripheral nerve function.
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.