Lilley: Pharmacology and the Nursing Process, 6th Edition

Angiotensin II Receptor Blockers Clinical Reference - Category Catchers

Category Catcher Angiotensin II Receptor Blockers

Mechanism of Action and Therapeutic Effects Angiotensin II receptor blockers (ARBs) block the binding of angiotensin II (AII) to type 1 AII receptors (AT1 receptors). The therapeutic effects of ARBs are seen primarily in vascular smooth muscle and the adrenal gland. By selectively blocking the binding of AII to the AT1 receptor, ARBs block vasoconstriction and the secretion of aldosterone. ARBs do not prevent the breakdown of bradykinin, thus decreasing the risk for nonproductive cough that may occur with ACE inhibitors.

Contraindications/Precautions Drug allergy, second and third trimester pregnancy, being elderly, and renal dysfunction

Drug Interactions Increased effects occur with cimetidine. Decreased effects occur with phenobarbital and rifampin. Risk for lithium toxicity occurs if administered concurrently with lithium

Adverse Effects Effects most commonly include upper respiratory infections and headache. Dizziness, insomnia, diarrhea, dyspnea, heartburn, nasal congestion, back pain, and fatigue can occur. Rarely, anxiety,

Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Clinical Reference - Category Catchers muscle pain, sinusitis, and cough occur. Hyperkalemia is much less likely to occur than with ACE inhibitors.

Nursing Implications Assess blood pressure and apical pulse prior to administration. Know that the dose may have to be reduced if the patient has hypovolemia or hepatic dysfunction. Monitor for angioedema and notify the health care provider immediately if it occurs. Monitor fluid volume status.

Patient Teaching Take medications exactly as prescribed. Do not stop taking them abruptly. Report any unusual shortness of breath, dyspnea, weight gain, chest pain, or palpitations to the health care provider immediately. The drug may cause dizziness, fainting, or light-headedness. Rise slowly to a sitting or standing position to minimize orthostatic hypotension. Monitor blood pressure and be sure to understand what parameters to report.

Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.