| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Amlodipine (Norvasc)—PO 5–10 mg daily | Hypertension, angina pectoris, vasospastic (Prinzmetal’s) angina, muscle cells | Inhibits the transport of calcium into myocardial and vascular smooth muscle | Arrhythmias, peripheral edema, heart failure; photosensitivity; gingival hyperplasia |
| NURSING IMPLICATIONS: Instruct client to: monitor pulse, report rate <50 beats/min, take with or without food | |||
| Diltiazem (Cardizem)—PO 30–120 mg 3–4 times/day; IV 5–15 mg/hr | Angina, hypertension, atrial arrhythmias | Inhibits excitation-contraction coupling; decreased SA, AV node conduction | Headache, fatigue, arrhythmias, edema, hypotension; constipation; rash |
| NURSING IMPLICATIONS: May take with meals; take pulse; do not give drug if pulse <50 beats/min; change positions slowly; may take nitroglycerin sublingually concurrently | |||
| Metoprolol (Lopressor)—PO 100 mg/day up to 450 mg/day | Hypertension | Blocks stimulation of myocardial adrenergic receptors (beta1) | Contraindicated in: congestive heart failure (CHF), pulmonary edema; caution with renal impairment |
| NURSING IMPLICATIONS: Monitor vital signs, especially BP; prevent orthostatic hypotension; avoid self-medication with OTC; may cause drowsiness; medication may increase sensitivity to cold | |||
| Nicardipine (Cardene)—PO 20–40 mg 3 times daily | Angina, hypertension | Inhibits excitation-contraction coupling | Dizziness, light-headedness, headache; peripheral edema; flushing |
| NURSING IMPLICATIONS: Give on an empty stomach; chest pain may occur 30 min after dose (temporary, from reflex tachycardia ) | |||
| Nifedipine (Procardia)—PO 10–30 mg 3 times daily ( not to exceed 180 mg/day); sublingual 10 mg repeated in 15 min | Angina, hypertension Obstetric use: may be used for premature labor; not FDA approved for use as tocolytic agent, but widely used | Vasodilation | Dizziness, light-headedness, giddiness, headache, nervousness; nasal congestion; sore throat, dyspnea, cough, wheezing; nausea; flushing, warmth |
| NURSING IMPLICATIONS: May take with meals; make position changes slowly; angina may occur 30 min after dose (temporary) | |||
| Verapamil (Calan, Isopten)—PO 240–480 mg, 3–4 times/day; IV 75–150 mcg/kg over 2 min | Angina; supraventricular arrhythmias; essential hypertension | Inhibits calcium movement into smooth-muscle cells; lowers pressure by reducing cardiac contractility | Constipation, AV block, hepatotoxicity |
 NURSING IMPLICATIONS: Monitor VS and ECG for bradycardia and arrhythmias ; observe for jaundice, abdominal pain; encourage fluids and bulk-forming foods | |||