Drug Study

Colleen S.
De la Rosa
BSN III
Drug Study
Brand Name &
Generic Name
Norvasc
(amlodipine
besylate)
Indication
Mechanism of Action
Dosage
Adverse Reaction
Nursing Consideration
1st-line
treatment
of
HTN
&
myocardial
ischemia.
Reduce the risk
of
coronary
revascularizatio
n & the need for
hospitalization
due to angina in
patients
w/
CHD; reduce the
risk of fatal
CHD, nonfatal
MI & to reduce
the
risk
of
stroke.
Amlodipine is a dihydropyridine calcium

antagonist (calcium ion antagonist or slowchannel
blocker)
that
inhibits
the
transmembrane influx of calcium ions into
vascular smooth muscle and cardiac muscle.
Experimental data suggest that amlodipine binds
to both dihydropyridine and nondihydropyridine
binding sites. The contractile processes of
cardiac muscle and vascular smooth muscle are
dependent upon the movement of extracellular
calcium ions into these cells through specific
ion channels. Amlodipine inhibits calcium ion
influx across cell membranes selectively, with a
greater effect on vascular smooth muscle cells
than on cardiac muscle cells. Negative inotropic
effects can be detected in vitro but such effects
have not been seen in intact animals at
therapeutic doses. Serum calcium concentration
is not affected by amlodipine. Within the
physiologic pH range, amlodipine is an ionized
compound (pKa=8.6), and its kinetic interaction
with the calcium channel receptor is
characterized by a gradual rate of association
and dissociation with the receptor binding site,
resulting in a gradual onset of effect.
HTN,
chronic
stable
angina Initial dose:
5 mg once daily &
may be increased to
a max of 10
mg.Patients
w/
CAD Recommende
d dosage range: 510
mg
once
daily. Ped patients
6-17 yr Initial dose:
2.5-5 mg once
daily. Dose should
not exceed 5 mg
daily.
Flushing, fatigue,
edema, dizziness,
headache,
abdominal pain,
nausea,
palpitations
&
somnolence.
Assessment
History: Allergy to amlodipine, impaired hepatic or
renal function, sick sinus syndrome, heart block,
lactation, CHF
Physical: Skin lesions, color, edema; P, BP, baseline
ECG,
peripheral
perfusion,
auscultation;
R,
adventitious sounds; liver evaluation, GI normal
output; liver and renal function tests, urinalysis
Interventions
WARNING: Monitor patient carefully (BP, cardiac
rhythm, and output) while adjusting drug to therapeutic
dose; use special caution if patient has CHF.
Monitor BP very carefully if patient is also on nitrates.
Monitor cardiac rhythm regularly during stabilization
of dosage and periodically during long-term therapy.
Administer drug without regard to meals.
Teaching points
Take with meals if upset stomach occurs.
You may experience these side effects: Nausea,
vomiting (eat frequent small meals); headache (adjust
lighting, noise, and temperature; medication may be
ordered).
Report irregular heartbeat, shortness of breath, swelling
of
the
hands
or
feet,
pronounced
dizziness, constipation.
Brand Name &

Generic Name
Indication
Telmistran
(Micardis)
Treatment of
essential HTN.
Prevention of CV
morbidity &
mortality in
patients 55 yr at
high risk of CV
disease.
Mechanism of Action
Dosage
Adverse Reaction
Telmisartan is a member of a family

Treatment of
UTI, upper resp tract
of drugs called angiotensin receptor
essential
infection, sepsis, anemia,
blockers
(ARBs),
which HTN Recommended
eosinophilia,
includes losartan (Cozaar), valsartan (
dose: 40 mg once
thrombocytopenia,
Diovan), irbesartan (Avapro),
and daily. Prevention of
anaphylactic reaction,
candesartan (Atacand). Angiotensin,
CV morbidity &
hypersensitivity,
formed in the blood by the action mortality Recomme
hyperkalemia,
of angiotensin
converting
nded dose: 80 mg
hypoglycemia, insomnia,
enzyme (ACE),
is
a
powerful
once daily.
depression, anxiety, syncope,
chemical that attaches to angiotensin
visual disturbance, vertigo,
receptors found in many tissues but
bradycardia, tachycardia,
primarily on muscle cells of blood
hypotension, orthostatic
vessels. Angiotensin's attachment to
hypotension, dyspnea,
the receptors causes muscle cells to
abdominal pain, diarrhea,
shorten and narrow the blood vessels
dyspepsia, flatulence,
(vasoconstrict), which leads to an
vomiting, dry mouth,
increase
in blood
stomach discomfort, pruritus,
pressure (hypertension). Telmisartan
hyperhidrosis, rash,
blocks the angiotensin receptor. By
angioedema, eczema,
blocking the action of angiotensin,
erythema, urticarial, drug
telmisartan widens blood vessels
eruption, toxic skin eruption,
(vasodilate) and reduces blood
back pain, muscle spasm,
pressure
myalgia, arthralgia, pain in
extremity, tendon pain, renal
impairment including acute
renal failure, chest pain,
asthenia, influenza-like
illness.
Nursing Consideration
special precaution inpatients

with impaired hepatic and
renal impairment
-special precaution with volume

and ./or Na-depleted patients
-may impair ability to drive or

operate machineries

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Colleen S.

Amlodipine is a dihydropyridine calcium

Brand Name &

Telmisartan is a member of a family

special precaution inpatients

-special precaution with volume

-may impair ability to drive or

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