Ramipril

INTRODUCTION

Indications

Alone or with other agents in the management of hypertension. Reduction of risk of myocardial infarction, stroke, or death from cardiovascular causes in patients at least 55 years of age who are at high-risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least 1 other cardiovascular risk factor. Reduction of risk of death, heart failure–related hospitalizations and progression of heart failure in patients with signs of heart failure following myocardial infarction.

Action

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 hypertensive patients. ↓ risk of myocardial infarction, stroke, or death from cardiovascular causes in high-risk patients. Increased survival and decreased heart failure progression after myocardial infarction.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache, vertigo, weakness. Resp: cough. CV: hypotension, chest pain. GI: diarrhea, nausea, vomiting. GU: impaired renal function. Derm: rashes. F and E: hyperkalemia. 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 document 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.

• 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 and vertigo 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.

Interventions

• 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 patient with coronary artery disease, diabetes mellitus, or other cardiovascular risk ...