Epoprostenol

INTRODUCTION

Indications

Management of primary pulmonary hypertension (PPH) and secondary pulmonary hypertension associated with scleroderma in New York Heart Association (NYHA) class III and IV patients who are no longer responding to standard therapy.

Action

A prostaglandin that directly dilates pulmonary and systemic arterial vasculature. Also inhibits platelet aggregation. Therapeutic Effects: Provides symptomatic improvement in patients with PPH and pulmonary hypertension secondary to scleroderma and increases survival in patients with PPH.

Adverse Reactions/Side Effects

CNS: anxiety, headache, dizziness. Resp: dyspnea. CV: tachycardia, bradycardia, chest pain, hypotension. GI: nausea, vomiting, abdominal pain, diarrhea. Derm: flushing. MS: myalgia, jaw pain. Neuro: hypesthesia/hyperesthesia/paresthesia. Misc: flu-like symptoms, injection-site reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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, dyspnea, fainting, and fatigue/weakness.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any muscle or jaw 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 signs of parasthesia (numbness, tingling) or increased/abnormal sensation. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess IV site during and after IV administration, and report any pain, swelling, inflammation, or other injection-site reactions.

Interventions

• Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, 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 BP.

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged headache, anxiety, skin flushing, flu-like symptoms, or GI problems (nausea, vomiting, diarrhea, abdominal pain).