increased weekly to 100-450 mg/day; Angina pectoris; 100 mg/day in 2 divided doses,can be increased weekly until response obtained or heart rate slows; effective dose is100-400 mg/day; Aggressive behavior: 200-300 mg/day; Ventricular arrhythmias: 200mg/day: IV: Early MI treatment: Three IV bolus injections of 5 mg each at approx. 2 minintervals; then give 50 mg q 6 hr PO starting 15 min after last IV dose; continue for 48hrs then 100 mg twice a day, continue for 1-3 monthsADVERSE REACTIONS: Fatigue, dizziness, depression, shortness of breath,bradycardia, diarrhea
INTERACTIONS: Oral contraceptives/quinidine – may ↑ metoprolol effects;diphenhydramine - ↓ metoprolol clearance → prolonged negative chronotropic andinotropic effects in extensive metabolizers; methimazole/propylthiouracil – may ↓metoprolol effects; rifampin - ↓ metoprolol effect related to ↑ liver metabolismCONTRAINDICATIONS: MI in clients with a heart rate of less than 45 bpm, insecond- or third-degree heartblock, or if SBP is less than 100 mm Hg; moderate to severecardiac failureNURSING CONSIDERATIONS: Do not confuse metoprolol with metoclopramide,metaproterenol, or misoprostol; if transcient worsening of heart failure occurs, treat withincreased doses of diuretics; may need to lower dose of metoprolol or temporarilydiscontinue; for CHF, do not increase dose until symptoms of worsening CHF have beenstabilized; if CHF clients experience symptomatic bradycardia, reduce dose; take doseeach day at same time; do not stop suddenlyGENERIC NAME: AMLODIPINETRADE NAME: Amvaz, Norvasc
CLASSIFICATION: Calcium Channel BlockerACTION: Inhibits influx of calcium through the cell membrane, resulting in depressionof automaticity and conduction velocity in cardiac muscle; decreases SA and AVconduction and prolongs AV node effective and functional refractory periods; slightdecrease in heartrate; possible slight decrease in myocardial contractility; cardiac outputis increased; moderate decrease in peripheral vascular resistanceINDICATIONS: Hypertension alone or in combination with other antihypertensives;chronic stable angina alone or in combination with other antianginal drugs; vasospasticangina alone or in combination with other antianginal drugsROUTES OF ADMINISTRATION: TabletsUSUAL DOSAGE: 5 mg/day, up to maximum of 10 mg/day; titrate dose over 7-14 daysADVERSE REACTIONS: Edema, palpitations, dizziness/lightheadedness, headache,fatigue/lethargy, flushing
INTERACTIONS: Diltiazem - ↑ plasma levels of amlodipine → further ↓ BP; grapefruitjuice - ↑ plasma amlodipine levels; Ranitidine - ↑ effect of CCBs related to ↓first-passmetabolismCONTRAINDICATIONS: Use with grapefruit juiceNURSING CONSIDERATIONS: Do not confuse Norvasc with Navane; food does notaffect bioavailability; elderly clients, small/fragile clients, or clients with hepaticinsufficiency may be started on 2.5 mg/day; take as directed once daily; may take with orwithout meals (food helps decrease stomach upset); report signs/symptoms of chest pain,SOB, dizziness, swelling of extremities, irregular pulse, altered vision immediatelyGENERIC NAME: IPRATROPIUM BROMIDE
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- Summer '16
- adverse reactions, Nursing Considerations, Usual dosage