Verapamil HCl Drug Study

Friday, February 20, 2009

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.


Verapamil hydrochloride

Brand Name: Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM,

Pregnancy Category C

Drug classes: Calcium channel-blocker, Antianginal agent, Antiarrhythmic, Antihypertensive

Therapeutic actions

Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; calcium is involved in the generation of the action potential in specialized automatic and conducting cells in the heart, in arterial smooth muscle, and in excitation-contraction coupling in cardiac muscle cells; inhibition of transmembrane calcium flow results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, the depression of myocardial contractility, and the dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac energy consumption, and in patients with vasospastic (Prinzmetal's) angina, increased delivery of oxygen to myocardial cells.

Indications

· Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina)

· Effort-associated angina

· Chronic stable angina in patients who cannot tolerate or do not respond to beta-adrenergic blockers or nitrates

· Unstable, crescendo, preinfarction angina

· Essential hypertension (sustained-release oral only)

· Treatment of supraventricular tachyarrhythmias (parenteral)

· Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation (parenteral)

· Unlabeled oral uses: paroxysmal supraventricular tachycardia, migraine headache, nocturnal leg cramps, hypertrophic cardiomyopathy

Contraindications

· Contraindicated with allergy to verapamil; sick sinus syndrome, except with ventricular pacemaker; heart block (second- or third-degree); hypotension; pregnancy; lactation.

· Use cautiously with idiopathic hypertrophic subaortic stenosis, cardiogenic shock, severe CHF, impaired renal or hepatic function, and in patients with atrial flutter or atrial fibrillation and an accessory to bypass tract.

Adverse effects

Dizziness, vertigo, emotional depression, sleepiness, headache, Peripheral edema, hypotension, arrhythmias, bradycardia; AV heart block, Nausea, constipation, Muscle fatigue, diaphoresis, rash

· Increased cardiac depression with beta-adrenergic blocking agents

· Additive effects of verapamil and digoxin to slow AV conduction

· Increased serum levels of digoxin, carbamazepine, prazosin, quinidine

· Increased respiratory depression with atracurium, gallamine, pancuronium, rucuronium, tubocurarine, vecuronium

· Risk of serious cardiac effects with IV beta-adrenergic blocking agents; do not give these drugs within 48 hr before or 24 hr after IV verapamil

· Decreased effects with calcium, rifampin

· Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to therapeutic dose. Dosage may be increased more rapidly in hospitalized patients under close supervision.

· Ensure that patient swallows SR tablets whole: do not cut, crush, or chew.

· Monitor BP very carefully with concurrent doses of antihypertensives.

· Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy.

· Administer sustained-release form in the morning with food to decrease GI upset.

· Protect IV solution from light.

· Monitor patients with renal or hepatic impairment carefully for possible drug accumulation and adverse reactions.

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