amlodipine besylate Nursing Considerations & Management

Amlodipine besylate (Norvasc) is a calcium channel-blocker that is usually indicated for patients with angina pectoris due to coronary artery spasms.

Generic Names & Brand Names

amlodipine besylate

(am loe‘ di peen)

Norvasc

Pregnancy Category C

Drug classes

• Calcium channel-blocker
• Antianginal drug
• Antihypertensive

Therapeutic actions

Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane calcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, depression of myocardial contractility, and dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac oxygen consumption, and in patients with vasospastic (Prinzmetal’s) angina, increased delivery of oxygen to cardiac cells.

Indications

• Angina pectoris due to coronary artery spasm (Prinzmetal’s variant angina)
• Chronic stable angina, alone or in combination with other agents
• Essential hypertension, alone or in combination with other antihypertensives

Contraindications and cautions

• Contraindicated with allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block (second or third degree), lactation.
• Use cautiously with CHF, pregnancy.

Available forms

Tablets—2.5, 5, 10 mg

Dosages

ADULTS

Initially, 5 mg PO daily; dosage may be gradually increased over 10–14 days to a maximum dose of 10 mg PO daily.

PEDIATRIC PATIENTS

Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC IMPAIRMENT

Initially, 2.5 mg PO daily; dosage may be gradually adjusted over 7–14 days based on clinical assessment.

Pharmacokinetics

Metabolism: Hepatic; T_1/2: 30–50 hr

Distribution: Crosses placenta; may enter breast milk

Excretion: Urine

Adverse effects

• CNS: Dizziness, light-headedness, headache, asthenia, fatigue, lethargy
• CV: Peripheral edema, arrhythmias
• Dermatologic: Flushing, rash
• GI: Nausea, abdominal discomfort

Interactions

Drug-drug

• Possible increased serum levels and toxicity of cyclosporine if taken concurrently

Nursing considerations

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.