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NURS 133 Diltiazem and Amlodipine

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jasmine's version from 2016-06-03 02:02

Section 1

Question Answer
Diltiazem Calcium channel blockers; Anti-anginals; Anti-arrhythmics; Anti-hypertensives; Pregnancy Category C; Hypertension; angina pectoris and vasospastic (Prinzmetal’s) angina; Supraventricular tachyarrhythmias and rapid ventricular rates in atrial flutter or fibrillation
Diltiazem actions Inhibits transport of calcium into myocardial and avascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction
Diltiazem therapeutic uses Systemic vasodilation resulting in decreased BP; Coronary vasodilation resulting in decreased frequency and severity of attacks of angina; Reduction of ventricular rate in atrial fibrillation or flutter
Elimination/Excretion of Diltiazem Mostly metabolized by the liver (CYP3A4 enzyme system)
Adverse/Side Effects of Diltiazem Arrhythmias, HF, peripheral edema; Stevens-Johnsons disease
Contraindications of Diltiazem Hypersensitivity; Sick sinus syndrome; 2nd or 3rd degree AV block (unless an artificial pacemaker is in place); Systolic BP less than 90 mmHg; Recent MI or pulmonary congestion; Concurrent use of rifampin
Use Diltiazem cautiously in Severe hepatic impairment; Geri: Increase risk of hypotension; Consider age related decrease in body mass, decrease hepatic/renal/cardiac function, concurrent drug therapy and other disease states; Severe renal impairment; Serious ventricular arrhythmias or HF; OB, Lactation, Pedi: Safety not established
Drug/Food interactions of Diltiazem Increase hypotension may occur when used with fentanyl, other anti-hypertensives, nitrates, acute ingestion of alcohol, or quinidine; Anti-hypertensive effects may be decrease by NSAIDs; May increase digoxin levels; May increase levels of and risk of myopathy from simvastatin and lovastatin; Concurrent use with beta blockers, clonidine, digoxin, disopyramide, or phenytoin may result in bradycardia, conduction defects, or HF; Phenobarbital and phenytoin may increase metabolism and decrease effectiveness; May decrease metabolism of and increase risk of toxicity form cyclosporine, quinidine, or carbamazepine; Cimetidine and ranitidine increase levels and effects; May increase or decrease the effects of lithium or theophylline; Grape fruit juice increase levels and effect
Medication administration of Diltiazem PO; IV
Nursing interventions of Diltiazem Monitor BP and pulse prior to therapy, during dose titration, and periodically during therapy; Monitor ECG periodically during prolonged therapy (may cause prolonged PR interval; Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention); Monitor frequency of prescription refills to determine adherence; Patients receiving digoxin concurrently with calcium channel blockers should have routine serum digoxin levels checked 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 angina pain; Arrhythmias: Monitor ECG continuously during administration. Report bradycardia or prolonged hypotension promptly. Emergency equipment and medication should be available. Monitor BP and pulse before and frequently during administration; Lab test considerations: Monitor serum potassium periodically (hypokalemia increase the risk of arrhythmias and should be corrected; Monitor renal and hepatic functions periodically during long-term therapy (may cause increase in hepatic enzymes after several days of therapy, which return to normal on discontinuation of therapy)
Implementation of Diltiazem May be administered without regards to meals-may be administered with meals if GI irritation; Do not open, crush, break, or chew sustained-released capsules or tablets; Empty tablets that appear in stool are not significant; Crush and mix diltiazem with food or fluids for patients having difficulty swallowing
Client education of Diltiazem Advise patient to take medication as directed at the same time each day, even if feeling well; Advise patient to avoid large amounts (6-8 glasses of grapefruit juice/day) during therapy; Instruct patient on correct technique for monitoring pulse; Instruct patient to contact health care professional if heart rate is less than 50 bpm; Caution patient to change positions slowly to minimize orthostatic hypotension; Advise patient to avoid driving or other activities requiring alertness until response to the medication is known; 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 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 heartbeats, 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 reactions; Angina: Instruct patient on concurrent nitrate or beta blocker therapy to continue taking both medications as directed and to use SI. Nitroglycerin as needed for angina attacks; 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 severe, persistent headache occurs; 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 yet 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
Evaluation/Desired outcomes of Diltiazem Decrease BP; Decrease in frequency and severity of angina attacks; Decrease in need for nitrate therapy; Increase in activity tolerance and sense of well-being; Suppression and prevention of tachy-arrhythmias
Potential nursing diagnoses of Diltiazem Acute pain (indications); Decreased cardiac output (adverse reactions)
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Section 2

Question Answer
Amlodipine Anti-hypertensives; calcium channel blocker; Pregnancy category C; alone or with other agents in the management of hypertension, angina pectoris, and vasospastic (Prinzmetal’s) angina
Amlodipine actions Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction
Amlodipine therapeutic uses Systemic vasodilation resulting in decreased BP; Coronary vasodilation resulting in decreased frequency and severity of attacks of angina
Elimination/Excretion of Amlodipine Mostly metabolized by the liver
Adverse/Side Effects of Amlodipine Peripheral edema
Contraindications of Amlodipine Hypersensitivity; Systolic BP less than 90 mmHg
Use Amlodipine cautiously in Severe hepatic impairment; Aortic stenosis; history of HF; OB, Lactation, , Pedi: Safety not established in children less than 6 years of age; Geri: Risk of hypotension
Drug/Food interactions of Amlodipine Strong CYP3A4 inhibitors, including ketoconazole, itraconazole, and ritonavir may increase levels; Additive hypotension may occur when used concurrently with fentanyl, other anti-hypertensives, nitrates, acute ingestion of alcohol, or quinidine; anti-hypertensive effects may be decrease by concurrent use of non-steroidal anti-inflammatory agents; May increase risk of neurotoxicity with lithium; Increase risk of myopathy with simvastatin (do not exceed 20 mg/day of simvastatin); may increase cyclosporine levels; Grape fruit juice increase serum levels and effect
Medication administration of Amlodipine PO
Nursing interventions of Amlodipine 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); Angina: Assess location, duration, intensity, and precipitating factors of patient’s anginal pain; Lab test considerations: Total serum calcium concentration are not affected by calcium channel blockers
Client education of Amlodipine Advise patient to take medication as directed, even if feeling well; Advise patient to avoid large amounts (6-8 glasses of grapefruit juice/day) during therapy; Instruct patient on correct technique for monitoring pulse; Instruct patient to notify health care professional if heart rate is less than 50 bpm; Caution patient to change positions slowly to minimize orthostatic hypotension; Advise patient to avoid driving or other activities requiring alertness until response to the medication is known; 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 avoid alcohol, and to consult health care professional before taking any new medications, especially cold preparations; Advise patient to notify health care professional if irregular heartbeats, 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 reactions; Angina: Instruct patient on concurrent nitrate or beta blocker therapy to continue taking both medications as directed and to use SI. Nitroglycerin as needed for anginal attacks; Advise patient to contact health care professional if chest pain does not improve or worsens after therapy, if it occurs with diaphoresis, if shortness of breath occurs, or if severe, persistent headache occurs; 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 yet 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
Evaluation/Desired outcomes of Amlodipine 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
Potential nursing diagnoses of Amlodipine Ineffective tissue perfusion (indications); Acute pain (indications)
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