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INTRODUCTION

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olmesartan medoxomil (ole-me-sar-tan me-dox-oh-mil)

Benicar

Classification

Therapeutic: antihypertensives

Pharmacologic: angiotensin II receptor antagonists

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Indications
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Hypertension (alone or with other agents).

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Action
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Blocks 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.

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Adverse Reactions/Side Effects
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CNS: dizziness. CV: hypotension. F and E: hyperkalemia. GU: impaired renal function. Misc: ANGIOEDEMA.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert 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 if these signs occur.

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

  • 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 unusual weakness and fatigue that might be due to high potassium levels (hyperkalemia) or other electrolyte imbalances.

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Interventions
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  • 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.

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Patient/Client-related Instruction
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  • 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 to report signs of impaired renal function, including decreased urine output, cloudy urine, or sudden weight gain due to fluid retention.

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Pharmacokinetics
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Absorption: Olmesartan medoxomil is a prodrug that is converted to olmesartan (the active component); 26% bioavailability of olmesartan.

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Distribution: Crosses the placenta.

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Protein Binding: 99%.

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Metabolism and Excretion: No further metabolism following conversion of prodrug to active drug; 35–50% excreted unchanged in urine; remainder eliminated in feces via bile.

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Half-life: 13 hr.

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TIME/ACTION PROFILE (antihypertensive effect with chronic dosing)

ROUTE ONSET PEAK DURATION

PO

within 1 wk

2 wk

24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Bilateral renal artery stenosis; OB: Can cause injury or death of fetus—if pregnancy occurs, discontinue immediately; Lactation: Discontinue olmesartan or provide formula.

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