niCARdipine (Perdipine) Drug Study
Brand Names: Cardene, Cardene SR, Cardene IV, Perdipine
Classification: Therapeutic: antianginals, antihypertensives; Pharmacologic: calcium channel blockers.
Indications
Management of: Hypertension, Angina pectoris, Vasospastic (Prinzmetal’s) angina. Unlabeled uses: Management of CHF.
Mechanism of Action
Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Therapeutic Effects: Systemic vasodilation resulting in decreased blood pressure. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina.
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Sick sinus syndrome; 2nd- or 3rd-degree AV block (unless an artificial pacemaker is in place); BP <90mmHg; Advanced aortic stenosis. Use Cautiously in: Severe hepatic impairment (dose reduction recommended); Geri: Geriatric patients (dose reduction/slower IV infusion rates recommended formost agents; increased risk of hypotension); Severe renal impairment (dose reduction may be necessary); History of serious ventricular arrhythmias or CHF; OB, Lactation, Pedi: Pregnancy, lactation, or children (safety not established).
Adverse Reactions/Side Effects
CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, jitteriness, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea, shortness of breath. CV: ARRHYTHMIAS, CHF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia. GI: abnormal results in liver function studies, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting. GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency. Derm: dermatitis, erythemamultiforme, flushing, increased sweating, photosensitivity, pruritus/urticaria, rash. Endo: gynecomastia, hyperglycemia. Hemat: anemia, leukopenia, thrombocytopenia. Metab: weight gain. MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.
Route/Dosage
PO (Adults): 20mg 3 times daily,may increase q3 days (range 20–40mg 3 times daily); or 30 mg twice daily as sustained-release form (up to 60mg twice daily). IV (Adults): To replace PO use—0.5–2.2mg/hr continuous infusion. For acute hypertensive episodes—5mg/hr titrated as needed (up to 15 mg/hr).
Nursing Management
1. Advise patient to take medication exactly as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
2. Instruct patient on technique for monitoring pulse. Instruct patient to contact health care professional if heart rate is <50 bpm.
3. Advise patient to avoid grapefruit and grapefruit juice during therapy.
4. Caution patient to change positions slowly to minimize orthostatic hypotension.
5. May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
6. Instruct patient to avoid concurrent use of alcohol or OTC medications, especially cold preparations, without consulting health care professional.
7. Advise patient to notify health care professional if irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness nausea, constipation, or hypotension occurs or if headache is severe or persistent.
8. Caution patient to wear protective clothing and to use sunscreen to prevent photosensitivity reactions.
9. Angina: Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks.
10. Advise patient to contact health care professional if chest pain does not improve, worsens
after therapy, or occurs with diaphoresis; if shortness of breath; or if persistent head ache occurs.
Classification: Therapeutic: antianginals, antihypertensives; Pharmacologic: calcium channel blockers.
Indications
Management of: Hypertension, Angina pectoris, Vasospastic (Prinzmetal’s) angina. Unlabeled uses: Management of CHF.
Mechanism of Action
Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Therapeutic Effects: Systemic vasodilation resulting in decreased blood pressure. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina.
Contraindicated in: Hypersensitivity; Sick sinus syndrome; 2nd- or 3rd-degree AV block (unless an artificial pacemaker is in place); BP <90mmHg; Advanced aortic stenosis. Use Cautiously in: Severe hepatic impairment (dose reduction recommended); Geri: Geriatric patients (dose reduction/slower IV infusion rates recommended formost agents; increased risk of hypotension); Severe renal impairment (dose reduction may be necessary); History of serious ventricular arrhythmias or CHF; OB, Lactation, Pedi: Pregnancy, lactation, or children (safety not established).
Adverse Reactions/Side Effects
CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, jitteriness, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea, shortness of breath. CV: ARRHYTHMIAS, CHF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia. GI: abnormal results in liver function studies, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting. GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency. Derm: dermatitis, erythemamultiforme, flushing, increased sweating, photosensitivity, pruritus/urticaria, rash. Endo: gynecomastia, hyperglycemia. Hemat: anemia, leukopenia, thrombocytopenia. Metab: weight gain. MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.
Route/Dosage
PO (Adults): 20mg 3 times daily,may increase q3 days (range 20–40mg 3 times daily); or 30 mg twice daily as sustained-release form (up to 60mg twice daily). IV (Adults): To replace PO use—0.5–2.2mg/hr continuous infusion. For acute hypertensive episodes—5mg/hr titrated as needed (up to 15 mg/hr).
Nursing Management
1. Advise patient to take medication exactly as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
2. Instruct patient on technique for monitoring pulse. Instruct patient to contact health care professional if heart rate is <50 bpm.
3. Advise patient to avoid grapefruit and grapefruit juice during therapy.
4. Caution patient to change positions slowly to minimize orthostatic hypotension.
5. May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
6. Instruct patient to avoid concurrent use of alcohol or OTC medications, especially cold preparations, without consulting health care professional.
7. Advise patient to notify health care professional if irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness nausea, constipation, or hypotension occurs or if headache is severe or persistent.
8. Caution patient to wear protective clothing and to use sunscreen to prevent photosensitivity reactions.
9. Angina: Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks.
10. Advise patient to contact health care professional if chest pain does not improve, worsens
after therapy, or occurs with diaphoresis; if shortness of breath; or if persistent head ache occurs.
Categories:
Calcium Channel Blockers,
Drug Study
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