Pharmacologic: angiotensin II receptor antagonists
Alone or with other agents in the management of hypertension.
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.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache. CV: hypotension. EENT: sinusitis. F and E: hyperkalemia. GI: abdominal pain, diarrhea, dyspepsia. GU: impaired renal function. MS: back pain, myalgia. Misc: ANGIOEDEMA.
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. Report these signs to the physician immediately.
Assess blood pressure periodically and compare to normal values (See Appendix F) to help document antihypertensive effects.
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.
Watch for and report signs of impaired renal function, including decreased urine output, cloudy urine, or sudden weight gain due to fluid retention.
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 anatomic or biomechanical problems.
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.
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.
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 or family/caregivers to report other troublesome side effects such as severe or prolonged headache, nasal inflammation, or GI problems (diarrhea, indigestion, abdominal pain).
Absorption: 42–58% absorbed following oral administration (bioavailability increased in patients with hepatic impairment).
Distribution: Crosses the placenta.
Metabolism and Excretion: Excreted mostly unchanged in feces via biliary excretion.