Unformatted text preview: ACTIVE LEARNING TEMPLATE: Medication Jessica Ramsawak
MEDICATION___________________________________________________________________________ REVIEW MODULE CHAPTER____________
_____________________________________________________________________ PURPOSE OF MEDICATION Expected Pharmacological Action
Inhibits calcium transport into myocardial and
vascular smooth muscle cells, resulting in inhibition
of excitation-contraction coupling and subsequent
contraction. Therapeutic Use
Systemic vasodilation, resulting in decreased BP.
Coronary vasodilation, resulting in decreased
frequency and severity of attacks of angina. Complications
CNS: headache, abnormal dreams, anxiety, confusion, dizziness, drowsiness, jitteriness, nervousness, psychiatric
disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea,
shortness of breath. CV: ARRHYTHMIAS, HF, peripheral edema, bradycardia, chest pain, hypotension, palpitations,
syncope, tachycardia. GI: ↑ liver enzymes, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, GI
obstruction, nausea, ulcer, vomiting. GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency. Derm:
flushing, dermatitis, erythema multiforme, ↑ 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. Medication Administration PO (Adults): 10–30 mg 3 times
daily (not to exceed 180
mg/day), or 10–20 mg twice
daily as immediate-release
form, or 30–90 mg once daily as
sustained-release (CC, XL) form
(not to exceed 90–120 mg/day). Contraindications/Precautions
Contraindicated in: Hypersensitivity; Sick sinus syndrome; 2nd- or 3rd-degree AV block (unless an artificial
pacemaker is in place); Systolic BP <90 mm Hg; Coadministration with grapefruit juice, rifampin, rifabutin,
phenobarbital, phenytoin, carbamazepine, or St. John’s wort.
Use Cautiously in: Severe hepatic impairment (↓ dose recommended); History of porphyria; Severe renal
impairment (↓ dose may be necessary); History of serious ventricular arrhythmias or HF; OB, Lactation: Use only if
potential benefit justifies potential risks; Pedi: Safety not established; Geri: Short-acting forms appear on Beers list
due to ↑ risk of hypotension and constipation (↓ dose recommended); also associated with ↑ incidence of falls. Interactions
Drug-Drug: Rifampin, rifabutin, phenobarbital, phenytoin, or carbamazepine may significantly ↓ levels and effects; concurrent use is contraindicated.
Ketoconazole, fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, saquinavir, indinavir, nelfinavir, or ritonavir may ↑ levels and effects;
consider initiating nifedipine at lowest dose. Additive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute
ingestion of alcohol, or quinidine. Antihypertensive effects may be ↓ by concurrent use of NSAIDs. May ↑ serum levels and risk of toxicity from digoxin.
Concurrent use with beta blockers, digoxin, or disopyramide may result in bradycardia, conduction defects, or HF. Cimetidine and propranolol may ↓
metabolism and ↑ risk of toxicity. May ↓ metabolism of and ↑ risk of toxicity from cyclosporine, tacrolimus, prazosin, quinidine, or carbamazepine. ↑ risk of
GI obstruction when used concurrently with H2 blockers, opioids, NSAIDs, laxatives, anticholinergic drugs, levothyroxine, or neuromuscular blockers.
Strong CYP3A4 inducers, including carbamazepine, phenobarbital, phenytoin, and rifampin may ↓ levels and effects; avoid concurrent use. Nursing Interventions
Monitor BP and pulse before therapy, during dose titration, and periodically during therapy.
Monitor ECG periodically during prolonged therapy.
Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral
edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
Patients receiving digoxin concurrently with nifedipine should have routine tests of serum
digoxin levels and be monitored for signs and symptoms of digoxin toxicity.
Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome.
Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle
or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
Angina: Assess location, duration, intensity, and precipitating factors of patient’s anginal
Lab Test Considerations: Total serum calcium concentrations are not affected by calcium
Monitor serum potassium periodically. Hypokalemia increases risk of arrhythmias; should
Monitor renal and hepatic functions periodically during long-term therapy. Several days of
therapy may cause ↑ hepatic enzymes, which return to normal upon discontinuation of
Nifedipine may cause positive ANA and direct Coombs’ test results. Drug-Natural Products: St. John’s wort may significantly ↓ levels and effects; concurrent use is contraindicated.
Drug-Food: Grapefruit and grapefruit juice ↑ serum levels and effect; avoid concurrent use. Evaluation of Medication Effectiveness Decrease in BP.
Decrease in frequency and severity of anginal attacks.
Decrease in need for nitrate therapy.
Increase in activity tolerance and sense of well-being. ACTIVE LEARNING TEMPLATES Client Education
Advise patient to take medication 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
Instruct patient on technique for monitoring pulse. Instruct patient to contact health care
professional if heart rate is <50 bpm.
Advise patient to avoid grapefruit or grapefruit juice during therapy.
Caution patient to change positions slowly to minimize orthostatic hypotension.
May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring
alertness until response to the medication is known.
Geri: Teach patients and family about risk for falls and how to reduce risk in the home.
Instruct patient on importance of maintaining good dental hygiene and seeing dentist frequently
for teeth cleaning to prevent tenderness, bleeding, and gingival hyperplasia (gum enlargement).
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal
products being taken and to avoid concurrent use of alcohol or OTC medications and herbal
products, especially cold preparations, without consulting health care professional.
Advise patient to notify health care professional if rash, irregular heartbeat, dyspnea, swelling of
hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if
headache is severe or persistent.
Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity
Angina: Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both
medications as directed and use SL nitroglycerin as needed for anginal attacks.
Inform patient that anginal attacks may occur 30 min after administration because of reflex
tachycardia. This is usually temporary and is not an indication for discontinuation.
Advise patient to contact health care professional if chest pain does not improve, worsens after
therapy, or occurs with diaphoresis; if shortness of breath occurs; or if persistent headache
Caution patient to discuss exercise restrictions with health care professional before exertion.
Hypertension: Encourage patient to comply with other interventions for hypertension (weight
reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular
exercise, and stress management). Medication controls but does not cure hypertension.
Instruct patient and family in proper technique for monitoring BP. Advise patient to take BP weekly
and to report significant changes to health care professional. Therapeutic Procedure A7 ...
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