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·         Lippincott illustrated reviews: Pharmacology (6th ed.). Philadelphia, PA: Wolters Kluwer.

·         Deglin, JH., & Vallerand AH., (2007). Davis’s drug guide for nurses (tenth edition). FA Davis company Philadelphia, Pennsylvania. ISBN: 978-0-8036-1156-6

·         Wilson et al., 2007 Prentice Hall Nurse's Drug Guide. Pearson.

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Assessment

-       Monitor blood pressure 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 signs of CHF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular vein distention)

-       Angina: assess location, duration, intensity, and precipitating factors of patient’s anginal pain

Implementation

-       PO: may be administered without regard to meals

Health Teaching

Instruct patient to:

-       Take missed doses as soon as possible unless almost time for the next dose; do not double doses

-       Contact physician if pulse rate is <50bpm

-       Caution patient to change position slowly to prevent hypotension

-       Avoid attention seeking activities or requiring alert until response to medication is unknown

-       Maintenance of good dental hygiene

-       Avoid use of alcohol or OTC medications especially cold preparations

-       Wear sunscreen and protective clothing

-       Take blood pressure weekly and to report significant changes

-       Hypertension: encourage patient to comply with other interventions for hypertension (low-sodium diet, weight reduction, regular exercise, etc.)

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

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CNS: headache, dizziness, fatigue
CV: peripheral edema, angina, bradycardia, hypotension, palpitations
GI: gingival hyperplasia, nausea
Derm: flushing

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Contraindicated in: Hypersensitivity. Blood pressure of >90mmhg
Use Cautiously in: Severe hepatic impairment, geriatric patients, aortic stenosis, and history of CHF

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Management for hypertension, angina pectoris, and vasospastic (Prinzmetal’s) angina

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Inhibits the transport of calcium into the 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

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Pharmacotherapeutic: antihypertensives
Clinical: calcium channel blockers

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PO (Geriatric patients): antihypertensive--- initiate therapy at 2.5mg/day, increase as required/tolerated (up to 10mg/day); antianginal-- initiate therapy at 5mg/day, increase as tolerated (up to 10mg/day)

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Generic Name : Norvasc

Brand Name: Actapin, Actimed Amlodipine, Alodine., Amaday., Ambes, Amcal, Amdipine, Amlodia

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Assessment

-       Monitor blood pressure, pulse, and respiratory status as indicated by severity of bleeding

-       Monitor for overt bleeding every 15-3-min

-       Monitor neurologic status in subarachnoid hemorrhage patients

-       Monitor intake and output ratios frequently

-       Monitor platelet count and clothing factors prior to and periodically throughout therapy

Implementation

-       Monitor IV site closely. Stabilize IV catheter to minimize thrombophlebitis

-       For intermittent infusion: Do not administer undiluted. Dilute initial 4-5g dose in 250ml of sterile water for injection

-       For continuous infusion: initial dose may be followed by a continuous infusion of 1g/hr in 50-100ml of diluent.

Health Teaching

-       Instruct patient to notify the nurse immediately if bleeding recurs or if thromboembolic symptoms develop

-       IV: Caution patient to make position changes slowly to avoid orthostatic hypotension

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CNS: dizziness, malaise

EENT: nasal stuffiness, tinnitus

CV: arrythmias, hypotension

GI: anorexia, bloating, cramping, diarrhea, nausea

GU: diuresis, renal failure

MS: myopathy

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Contraindicated in:  Active Intravascular clotting

Use Cautiously in: Upper urinary tract bleeding; cardiac, renal, or liver disease; pregnancy and lactation; disseminated intravascular coagulation.

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Management of acute, life -threatening hemorrhage due to systemic hyperfibrinolysis; prevention of recurrent subarachnoid hemorrhage. Prevention of bleeding following oral surgery in hemophiliacs.

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Inhibits action of plasminogen
Therapeutic Effect: Inhibition of fibrinolysis. Stabilization of clot formation

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Therapeutic: hemostatic agents

Pharmacologic: fibrinolysis inhibitors

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Acute bleeding syndromes due to elevated Fibrinolytic Activity:

PO (Adults): 5g 1st hr, followed by 1-1.25g q hr for 8hr or until hemorrhage is controlled

IV (Adults): 4-5g over 1st hr, followed by 1g/hr for 8hr or until hemorrhage is controlled

Subarachnoid Hemorrhage:

PO (Adults): to follow IV--- 3g q 2hr (36g/day). If no surgery is performed, continue for 21 days after bleeding stops, then decrease to 2g q 2hr (24g/day) for 3 days

IV (Adults): 36g/day for 10 days followed by PO

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Generic Name: Amicar, epsilon aminocaproic acid

Brand Name: Amicar