This drug is used alone or in combination with other medications to treat hypertension and heart failure (National Institutes of Health [NIH], 2017l). Losartan is an angiotensin II receptor blocker and was the 14th most prescribed drug in 2017. This drug is used alone or in combination with other medications to treat hypertension. Losartan works by “blocking” the receptor for angiotensin II and, as a result, has an impact on blood pressure and blood volume comparable to Lisinopril. Lisinopril is known to produce adverse reactions in the integument, pulmonary system, musculoskeletal system, and CNS (NIH, 2017l). Losartan is known to produce side effects in the musculoskeletal, gastrointestinal, and pulmonary systems as well as the integument. Swelling and edema may be observed with either medication (NIH, 2015c, 2017l). Metoprolol (ranked #6 in 2017, Table 17) and atenolol (ranked #18) are beta-1 receptor antagonists . Activation of the beta-1 receptor results in an increase in heart rate and blood pressure. Beta-1 receptor antagonists are used to limit, or blunt, increases in heart rate and blood pressure by “blocking” access to the beta-1 receptor (NIH, 2017n). The most common side effects related to metoprolol and atenolol occur in the integument, pulmonary system, GI system, and CNS (NIH, 2017d, 2017n). Amlodipine (ranked #9 in 2017, Table 17) is used alone or in combination with other drugs to treat high blood pressure and angina (NIH, 2017b). Amlodipine is a calcium channel blocker that acts to relax vascular smooth muscle in peripheral blood vessels, resulting in reduced blood pressure and increased blood flow. Amlodipine is known to produce side effects in the musculoskeletal system, GI system, and CNS (NIH, 2017b). Hydrochlorothiazide (ranked #10 in 2017, Table 17) and furosemide (ranked #15) are diuretics used to treat hypertension and edema by reducing excess water and salt from the body. Hydrochlorothiazide is known to produce side effects most commonly in the renal and GI systems (NIH, 2017h), while furosemide produces side effects in the musculoskeletal, GI, pulmonary, integument, and central nervous systems (NIH, 2017f). Hydrochlorothiazide and furosemide are potassium wasting diuretic ; (i.e., the use of these drugs causes a loss of potassium that must be supplemented. Hypokalemia (low potassium in the blood) produces dysrhythmias in the heart that may produce an abnormal pulse. This condition should be reported to the patient’s physician as soon as detected. Amplification is a term used to describe an exaggeration (amplification) of the intended therapeutic effect of a medication. Amplification is most likely to occur when a patient begins use of a new drug or has a change in dosage . Anti-hypertensive medications are notorious for amplification of an individual’s blood pressure lowering impact on high blood pressure resulting in the client suffering from hypotension and hypotensive symptoms (e.g., dizziness, lightheadedness, fatigue, and an elevated risk of falling). The appearance of hypotension should result in some affirmative answers to the general health questions and should be reported to the physician as soon as possible. Hyperlipidemia affects about one-third of adults in the U.S., and statins are frequently used to treat this condition (Di Stasi, MacLeod, Winters, & Binder-Macleod, 2010). Statins are used to lower the cholesterol level in the blood in an effort to reduce the overall risk of coronary artery disease (NIH, 2017q). This class of drugs includes simvastatin (ranked #4) and atorvastatin (ranked #5). Statins act on the liver to reduce endogenous cholesterol production, and as a result there is a small risk of liver toxicity leading to liver failure (NIH, 2015a, 2016b, 2017q). This risk is significantly elevated if the patient has a history of liver disease.
Blood tests for liver enzymes are used to monitor the negative impact of statins on liver function. Signs indicative of liver toxicity include a jaundiced appearance, edema, and unusual bleeding or bruising. Statins are also known to produce muscle cramping, soreness, fatigue, weakness, and myopathies, and these side effects often become more obvious during or after exercise. Therapists are well trained in assessing musculoskeletal conditions in patients and should be in a position to provide early identification of these side effects in their patients (Di Stasi et al., 2010). Additional adverse reactions to statins affect the integument as well as the musculoskeletal, GI, and pulmonary systems (NIH, 2015a, 2016b, 2017q). Levothyroxine (ranked #2 in 2017, Table 17) is a thyroid replacement hormone used to treat hypothyroidism; a hypometabolic state that results in weight gain, cold intolerance, and loss of hair (NIH, 2017k). Hypothyroidism affects approximately 20 million Americans and up to 60% of those people are unaware of the problem. Women are five to eight times more likely to develop hypothyroidism and one woman in eight will develop the condition (Goodman et al., 2018). Levothyroxine is used to correct the hormone deficiency and the hypometabolic state. The most common adverse reaction to thyroid replacement hormone is an amplified response, resulting in a hypermetabolic state (e.g., unexplained weight loss, heat intolerance, insomnia, cognitive/emotional changes) that should be reported to the physician (see Table 18). Serious side effects of thyroid replacement hormone that should be reported immediately to the physician include heart palpitations, tachycardia, and chest pain (NIH, 2017k). Metformin (ranked #3 in 2017, Table 17) is a glucose regulator used alone or in combination with other medications to help control blood glucose levels in patients with type 2 diabetes (NIH, 2017m). Metformin decreases glucose absorption from the gut and decreases glucose release by the liver. As a result, metformin may cause hypoglycemia and/or hyperglycemia in individuals receiving this drug (NIH, 2017m). Insulin (ranked #19) is a glucose regulator used alone or in combination with other drugs in patients with type 1 and type 2 diabetes (NIH, 2017j) to lower blood glucose levels. Insulin can now be inhaled as well as injected. Hypoglycemia can occur with the use of metformin and/or insulin and results in the onset of symptoms related to the CNS (e.g., shakiness, dizziness, lightheadedness, sweating, changes in mood and behavior, numbness, tingling, and confusion). Severe hypoglycemia can result in confusion, seizures, and loss of consciousness and is considered to be a medical emergency. Hyperglycemia can result in the onset of polyuria, polydipsia, polyphagia, weakness, and blurred vision. Metformin is known to produce adverse reactions in the GI and musculoskeletal systems (NIH, 2017m). Insulin is known to produce adverse reactions in the CNS, as well as the integument, GI system, and pulmonary system. Insulin may cause sudden weight gain and edema in the extremities (NIH, 2017j). Omeprazole (ranked #7 in 2017, Table 17) is a proton pump inhibitor (PPI) used to treat gastric erosions, ulcers, and gastroesophageal reflux disease. This drug acts to reduce the amount of acid secretion in the stomach (NIH, 2017o). The 2002 study by Boissonnault and Meek found that approximately 4% of the subjects reported use of a medication for an ulcer and 21% reported the use of antacids for GI distress. Omeprazole and other PPIs are known to produce adverse reactions in the integument, musculoskeletal, CNS, and the GI system. Concerns over the long-term use of PPIs were expressed in the Harvard Health Letter dating back to 2009 (Harvard Health Letter, 2009) and continue today (Ambizas & Etzel, 2017; Freedberg, Kim, & Yang, 2017). Long-term use of PPIs has now
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