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Bulsara, K. (2021). Amlodipine. Retrieved September 16, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK519508/

Skidmore-Roth, L. (2002). 2002 Mosby's Nursing drug reference. St. Louis, MO: Mosby.

Ogbru, O. (2019). Atenolol, Tenormin: Drug Facts, side effects and dosing. Retrieved September 16, 2021, from https://www.medicinenet.com/atenolol/article.htm

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Generic Name

Atenolol

Brand Name

Tenormin

Stock Dosage

Angina Pectoris

●      Adults: 50 mg/day PO; after 1 week, may be increased to 100 mg/day PO; some patients may require 200 mg/day

●      Older patients: 25 mg/day PO; after 1 week, may be increased to 100 mg/day; some patients may require 200 mg/day

Hypertension

●      Adults: 25-50 mg/day PO initially; may be increased to 100 mg/day PO

●      Older patients: 25 mg/day PO initially; may be increased to 100 mg/day PO

Classification

Functional class: Antianginal, Antihypertensive

Chemical class:  Beta-adrenergic blocker

Mechanism of Action

It inhibits stimulation of beta-receptor sites that are mainly in the heart by blocking the effects of epinephrine which then decreases cardiac excitability, cardiac output, blood pressure and myocardial oxygen demand. It also dilates veins and arteries to improve blood flow.

Indication/s

It is used to treat angina pectoris and high blood pressure.

Contraindications

●      Patients who have hypersensitivity to atenolol

●      2nd or 3rd degree heart block

●      Sinus Bradycardia

●      Heart failure

Side Effects and Adverse Effects

Side effects

●      Nausea

●      Dizziness

●      Drowsiness

●      Mood swings

●      Hallucination

●      Headache

●      Visual Disturbances

Adverse effects

●      CNS: Depression, disorientation, fatigue, lethargy, light-headedness, short-term memory loss, vertigo

●      CV: Arrhythmias, Bradycardia, Hypotension, Heart Block, Heart Failure, Mesenteric Artery Thrombosis, Mesenteric Artery Thrombosis, Mitral Insufficiency, Myocardial Reinfarction, Raynaud’s Phenomenon

●      GI: Diarrhea, Ischemic Colitis

●      Respiratory: Bronchospasm, Shortness Of Breath, Pulmonary Emboli, Respiratory Distress, Wheezing

●      Skin: Rashes

Nursing Responsibilities

●      Assess cardiac rhythm, blood pressure, pulse, respiratory rate.

●      Monitor blood pressure frequently.

●      Use cautiously in diabetic patients because it may mask tachycardia caused by hypoglycemia.

●      Assist when standing and walking due to dizziness and drowsiness side effects of the drug.

●      Instruct  the patient not to stop taking atenolol abruptly. Discontinuing abruptly may worsen angina, and MI or arrhythmia may occur.

●      Instruct to avoid hazardous activities until dizziness is no longer a problem.

●      Instruct to change position slowly, to prevent orthostatic hypotension.

●      Withhold atenolol and inform the physician if the patient develops bradycardia, hypotension, or other serious adverse reaction.

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Generic Name

Amlodipine

Brand Name

Norvasc

Stock Dosage

Angina and Coronary Artery Disease

●      Adults: Initially 5 mg/day PO may be increased by 2.5 mg/day every 7-14 days; not exceeding 10 mg/day maintenance

●      Older patients: Initially 5 mg PO daily

Hypertension

●      Adults: Initially 5 mg PO daily. Dosage adjusted according to patient response and tolerance. Titration should occur over 7 to 14 days. Maximum dose is 10 mg per day.

●      Older patients: Initially, 2.5 mg daily PO.

Classification

Functional class: Antianginal, Antihypertensive, Calcium Channel Blocker

Chemical class: Dihydropyridine

Mechanism of Action

It inhibits calcium ion influx across cardiac and smooth-muscle cells, dilates coronary vascular arteries, and relaxes coronary vascular muscles. Thereby, causing a decrease in myocardial oxygen demand, decrease in force of contraction of heart muscle, slowing down heart rate and decreasing blood pressure.

Indication/s

It is used to treat chronic stable angina, vasospastic angina, coronary artery disease, and high blood pressure.

Contraindications

●      Patients who have hypersensitivity to amlodipine

●      Sick sinus syndrome

●      2nd or 3rd degree heart block

●      Severe hypotension

Side Effects and Adverse Effects

Side effects

●      Nausea

●      Dizziness

●      Headache

●      Stomach pain

●      Drowsiness

●      Tiredness

Adverse effects

●      CNS: Fatigue, Anxiety, Insomnia

●      CV: Edema, Flushing, Dysrhythmia, Hypotension, Palpitation

●      GI: Diarrhea, Constipation, Gingival Hyperplasia

●      Respiratory: Pulmonary edema, Shortness of breath

●      Skin: Pruritus, Rash, Hair loss

Nursing Responsibilities

●      Assess cardiac rhythm, blood pressure, pulse, respiratory rate.

●      Monitor blood pressure frequently. Drug-induced vasodilation has a gradual onset, hypotension may not occur immediately.

●      Inspect for presence of peripheral edema, shortness of breath, rales or crackles that are signs of CHF.

●      Assist when standing and walking due to dizziness and drowsiness side effects of the drug.

●      Instruct the patient to avoid hazardous activities until dizziness is no longer a problem.

●      Instruct to change position slowly, to prevent orthostatic hypotension.

●      Instruct to continue with good oral hygiene to prevent gingival disease.

●      Instruct to promptly report adverse reactions