Losartan

INTRODUCTION

Indications

Alone or with other agents in the management of hypertension. Treatment of diabetic nephropathy in patients with type 2 diabetes. Prevention of stroke in patients with hypertension and left ventricular hypertrophy.

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. Decreased progression of diabetic nephropathy. Decreased incidence of stroke in patients with hypertension and left ventricular hypertrophy (effect may be less in black patients).

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache, insomnia, weakness. CV: chest pain, edema, hypotension. EENT: nasal congestion. Endo: hypoglycemia, weight gain. GI: diarrhea, abdominal pain, dyspepsia, nausea. GU: impaired renal function. F and E: hyperkalemia. MS: back pain, myalgia. Misc: ANGIOEDEMA, fever.

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 immediately of these signs.

• Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• 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 fluid retention.

• If treating diabetic neuropathy, establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible. Periodically reexamine these values to monitor peripheral nerve function and document whether drug therapy delays the progression of neuropathic disease.

• 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 anatomical or biomechanical problems.

• Monitor symptoms 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.

• Monitor signs of hypoglycemia, especially during and after exercise. Common neuromuscular symptoms include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Patients with diabetes mellitus should check blood glucose levels frequently.

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

• 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 body weight periodically and report ...