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Isbesartan

Generic Name Isbesartan


Brand Name
Apo-lrbesartan,
Avapro

Classification PHARMACOTHERAPEUTIC: Angiotensin II receptor


antagonist.
CLINICAL: Antihypertensive
General Action Blocks vasoconstriction, aldosterone-secreting effects of
angiotensin II, inhibiting binding of angiotensin II to AT1
receptors.
Therapeutic Effect: Produces vasodilation, decreases peripheral
resistance, decreases B/P.
Pharmocokinetics Route Onset Peak Duration
PO 1–2 hrs Greater than 24 hrs
Rapidly, completely absorbed after PO administration. Protein
binding: 90%. Metabolized in liver. Recovered primarily in
feces and, to a lesser extent, in urine. Not removed by
hemodialysis. Halflife: 11–15 hrs.

Interactions DRUG: Diuretics produce additive hypotensive effects.


Potassium-sparing diuretics, potassium supplements may
increase risk of hyperkalemia. NSAIDs may decrease
antihypertensive effect.
HERBAL: Ephedra, ginseng, yohimbe may worsen
hypertension. Garlic may increase antihypertensive effect.
FOOD: None known.
LAB VALUES: May slightly increase serum BUN, creatinine.
May decrease Hgb.
Indications/Routes/Dosage Hypertension PO:

ADULTS, ELDERLY, CHILDREN 13 YRS AND OLDER:


Initially, 75–150 mg/day. May increase to 300 mg/day.
CHILDREN 6–12 YRS: Initially, 75 mg/day. May increase to
150 mg/day. Nephropathy PO:
ADULTS, ELDERLY: Target dose of 300 mg once daily.
Dosage in Renal/Hepatic Impairment No dose adjustment.
Availability (Rx) Tablets: 75 mg, 150 mg, 300 mg.
Side effects Occasional (9%–3%): Upper respiratory tract infection, fatigue,
diarrhea, cough. Rare (2%–1%): Heartburn, dizziness, headache,
nausea, rash.
Adverse Effects/Toxic Overdose may manifest as hypotension, syncope, and
Reactions tachycardia. Bradycardia occurs less often.
Nursing Considerations Obtain B/P, apical pulse immediately before each dose, in
addition to regular monitoring (be alert to fluctuations). If
excessive reduction in B/P occurs, place pt in supine position,
feet slightly elevated. Question possibility of pregnancy (see
Pregnancy Category). Assess medication history (esp. diuretic
therapy).

INTERVENTION/EVALUATION Maintain hydration (offer


fluids frequently). Assess for evidence of upper respiratory
infection. Assist with ambulation if dizziness occurs. Monitor
electrolytes, renal function, urinalysis, B/P, pulse. Assess for
hypotension.

PATIENT/ FAMILY TEACHING: May cause fetal or neonatal


morbidity or mortality.
• Avoid tasks that require alertness, motor skills until response
to drug is established (possible dizziness effect); ensure
appropriate birth control measures are in place.
• Report any sign of infection (sore throat, fever).
•Avoid exercising during hot weather (risk of dehydration,
hypotension).

Source: Saunders Nursing Drug Handbook 2016

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