I.

DATE ORDERED:FEB 17,2009

II. DOSE ORDERED 5 N PER; ONE TAB OD

III. GENERIC NAME:

AMLODIPINE

IV. BRAND NAME:

Norvasc

V. CLASSIFICATION

• Calcium channel-blocker
• Antianginal drug
• Antihypertensive
VI. PREGNANCY CATEGORY:

Pregnancy Category C

VII. SUGGESTED DOSE:

Available Forms: Tablets--2.5, 5, 10 mg

Adult:
Initially 5 mg PO qd; dosage may be gradually increased over 10---14 d to a
maximum dose of 10 mg PO qd.

Pediatric:
Safety and efficacy not established.

Geriatric or Hepatic Impairment:

Initially, 2.5 mg PO qd; dosage may be gradually titrated over 7---14 d based on
clinical assessment
Pharmacokinetics

Route Onset Peak

Unknow 6---12
Oral
n h

Metabolism: Hepatic, T1/2: 30---50 h

Distribution: Crosses placenta; passes into breast milk

Excretion: Urine

VIII. MODE OF ACTION:

Inhibits the movement of calcium ions across the membranes of cardiac and
arterial muscle cells; inhibits transmembrane calcium flow, which results in
the depression of impulse formation in specialized cardiac pacemaker cells,
slowing of the velocity of conduction of the cardiac impulse, depression of
myocardial contractility, and dilation of coronary arteries and arterioles and
peripheral arterioles; these effects lead to decreased cardiac work, decreased
cardiac oxygen consumption, and in patients with vasospastic (Prinzmetal's)
angina, increased delivery of oxygen to cardiac cells.

IX. INDICATION:

• Angina pectoris due to coronary artery spasm (Prinzmetal's variant

angina)
• Chronic stable angina, alone or in combination with other agents
• Essential hypertension, alone or in combination with other
antihypertensives
X. CONTRAINDICATION:
  Contraindications: allergy to amlodipine, impaired hepatic or renal
function, sick sinus syndrome, heart block (second or third degree),
lactation
XI. DRUG INTERACTION:

• Drug-drug

o Possible increased serum levels and toxicity of cyclosporine if

taken concurrently
XII. SIDE AND ADVERSE EFFECTS:

• CNS: Dizziness, light-headedness, headache, asthenia, fatigue, lethargy

• GI: Nausea, abdominal discomfort
• CV: Peripheral edema, arrhythmias
• Dermatologic: Flushing, rash

XIII. NURSING RESPONSIBILITY:

 NURSING CONSIDERATIONS/ PRECAUTIONS

Assessment

•
History: Allergy to amlodipine, impaired hepatic or renal function, sick
sinus syndrome, heart block, lactation, CHF
Physical: Skin lesions, color, edema; P, BP, baseline ECG, peripheral
perfusion, auscultation; R, adventitious sounds; liver evaluation, GI normal
output; liver and renal function tests, urinalysis.
• Use cautiously with CHF
Implementation

• Monitor patient carefully (BP, cardiac rhythm, and output) while titrating
drug to therapeutic dose; use special caution if patient has CHF.
• Monitor BP very carefully if patient is also on nitrates.
• Monitor cardiac rhythm regularly during stabilization of dosage and
periodically during long-term therapy.
• Administer drug without regard to meals.
 PATIENT TEACHINGS

• Take with meals if upset stomach occurs.

• The following side effects may occur: nausea, vomiting (small, frequent
meals may help); headache (adjust lighting, noise, and temperature;
medication may be ordered).
• Report irregular heartbeat, shortness of breath, swelling of the hands or
feet, pronounced dizziness, constipation.
• Adverse effects in Italic are most common; those in Bold are life-
threatening.