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Amlodipine A to Z Drug Facts Amlodipine Action Indications Contraindications Route/Dosage Interactions Lab Test Interferences Adverse Reactions Precautions Patient Care Considerations Administration/Storage Assessment/Interventions Patient/Family Education (am-LOW-dih-PEEN) Norvasc Class: Calcium channel blocker Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle. Indications Hypertension; chronic stable angina; vasospastic (Prinzmetal's or variant) angina. Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block, except with a functioning pacemaker. Route/Dosage ADULTS: PO 5 to 10 mg qd. ELDERLY: PO Initially 2.5 mg qd. HEPATIC IMPAIRMENT PO Initially 2.5 mg qd. Interactions Beta-blockers: May cause increased adverse cardiac effects as a result of myocardial depression. Fentanyl: Severe hypotension or increased fluid volume requirements have occurred with similar drug. Lab Test Interferences None well documented. Adverse Reactions CV: Palpitations; peripheral edema; syncope; tachycardia; bradycardia; arrhythmias; ventricular asystoles. CNS: Headache; dizziness; lightheadedness; fatigue; lethargy; somnolence. DERM: Dermatitis; rash; pruritus; urticaria. GI: Nausea; abdominal discomfort; cramps; dyspepsia. RESP: Shortness of breath; dyspnea; wheezing. OTHER: Flushing; sexual difficulties; muscle cramps, pain or inflammation. Precautions Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. CHF: Cautious use is required with this condition. Hepatic impairment: Cautious use is required. PATIENT CARE CONSIDERATIONS Administration/Storage Administer medication in morning. If patient has difficulty swallowing, crush tablets. Store in tightly closed container in cool location. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Note any diabetes, liver disease, cardiac disease or sensitivity to calcium channel blockers. Monitor BP and pulse before administration. Review baseline ECG. Assess for signs of withdrawal syndrome. Abrupt withdrawal may cause increased frequency and duration of angina. Gradual tapering of dose is necessary. Assess patient for signs of CHF during therapy. If chest pain occurs, assess for location, intensity, duration, and radiation. Nitroglycerin preparations may be administered in conjunction with this medication. If drug is used with other calcium channel blockers or beta-blockers, observe for intensification of side effects. Withhold medication and notify physician if any of the following signs and symptoms occur: Sudden severe dyspnea; edema of hands and feet; changes in ECG (widened QRS, prolonged QT segments); pulse falls below 50 bpm. If the patient experiences chest pain not relieved by medication, continue medication and notify physician. OVERDOSAGE: SIGNS & SYMPTOMS Nausea, weakness, dizziness, drowsiness, confusion, slurred speech, hypotension, bradycardia, second- or third-degree AV block Patient/Family Education Teach patient how to monitor pulse before taking medication. Tell patient not to take medication if pulse if < 50 bpm and to call physician. Explain to patient how to monitor BP daily. Instruct patient not to stop taking this medication suddenly because doing so can cause chest pain and MI. Teach patient importance of good oral hygiene and frequent visits to dentist while taking medication. Inform patient that frequent follow-up appointments with physician are important to adjust medication dosage. Caution patient to avoid sudden position changes to prevent orthostatic hypotension. Instruct patient to avoid intake of alcoholic beverages or other CNS depressants. Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness. Instruct patient not to take otc medications without consulting physician. Books@Ovid Copyright © 2003 Facts and Comparisons David S. Tatro A to Z Drug Facts