Nursing Implications for Verapamil Hydrochloride

VERAPAMIL

HYDROCHLORIDE

(ver-ap′a-mill)

Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM

Classifications: CALCIUM CHANNEL BLOCKER; ANTIHYPERTENSIVE; CLASS IV ANTIARRHYTHMIC

Therapeutic: CLASS IV ANTIARRHYTHMIC; ANTIHYPERTENSIVE; ANTIANGINAL

Pregnancy Category: C

AVAILABILITY

Tablet; sustained release tablet; sustained release capsule; solution for injection

ACTION & THERAPEUTIC EFFECT

Inhibits calcium ion influx through slow channels into cells of myocardial and arterial smooth muscle. Dilates coronary arteries and arterioles and inhibits coronary artery spasm. Decreases and slows SA and AV node conduction without affecting normal arterial action potential or intraventricular conduction. Dilates peripheral arterioles, causing decreased total peripheral resistance, and this results in lowering the BP.

Decreases angina attacks by dilating coronary arteries and inhibiting coronary vasospasms. Decreases nodal conduction, resulting in an antiarrhythmic effect. Decreased total peripheral vascular resistance; and therefore, reduction in BP.

USES

Supraventricular tachyarrhythmias; Prinzmetal’s (variant) angina, chronic stable angina; unstable, crescendo or preinfarctive angina and essential hypertension.

UNLABELED USES

Paroxysmal supraventricular tachycardia, atrial fibrillation; prophylaxis of migraine headache; and as alternate therapy in manic depression.

CONTRAINDICATIONS

Severe hypotension (systolic less than 90 mm Hg), cardiogenic shock, cardiomegaly, digitalis toxicity, second- or thirddegree AV block; Wolff-Parkinson-White syndrome including atrial flutter and fibrillation; accessory AV pathway, left ventricular dysfunction, severe CHF, sinus node disease, sick sinus syndrome (except in patients with functioning ventricular pacemaker); lactation.

CAUTIOUS USE

Duchenne’s muscular dystrophy; hepatic and renal impairment; MI followed by coronary occlusion, aortic stenosis; GI obstruction, GERD, hiatal hernia, ileus; pregnancy (category C); extended release tablets: children younger than 18 y.

ROUTE & DOSAGE

Angina

Adult: PO 80 mg q6–8h, may increase up to 320–480 mg/day in divided doses (Note: Covera-HS must be given once daily at bedtime)

Hypertension

Adult: PO 80 mg t.i.d. or 90–240 mg sustained release 1–2 × day up to 480 mg/day (Note: Covera-HS must be given once daily at bedtime)

Supraventricular Tachycardia, Atrial Fibrillation

Adult/Adolescent (15 y or older): IV 5–10 mg after 30 min may give 10 mg (max total dose: 20 mg)

Child/Adolescent (up to 15 y): IV 0.1–0.3 mg/kg (do not exceed 5 mg)

Infant: IV 0.1–0.2 mg/kg may repeat after 30 min

Renal Impairment Dosage Adjustment

CrCl less than 10 mL/min: Give 50–75% of dose

Nursing Implications for Verapamil Hydrochloride

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Hemodialysis Dosage Adjustment

Supplemental dose not necessary

Hepatic Impairment Dosage Adjustment

Cirrhosis: Use 20–50% of normal dose

ADMINISTRATION

Oral

• Give with food to reduce gastric irritation.
• Capsules can be opened and contents sprinkled on food. Do NOT dissolve or chew capsule contents.
• Do not withdraw abruptly; may increase and extend duration of pain in the angina patient.

Intravenous

PREPARE: IV Direct:

Given undiluted or diluted in 5 mL of sterile water for injection.

Inspect parenteral drug preparation before administration. Make sure solution is clear and colorless.

ADMINISTER: Direct: Give a single dose over 2–3 min.

INCOMPATIBILITIES:

Solution/additive: Albumin, aminophylline, amphotericin B, hydralazine, trimethoprim/ sulfamethoxazole.

Y-site: Albumin, amphotericin B cholesteryl complex, ampicillin,  lansoprazole, mezlocillin, nafcillin, oxacillin, propofol, sodium bicarbonate.

• Store at 15°–30° C (59°–86° F) and protect from light.

ADVERSE EFFECTS (≥1%) CNS:

Dizziness, vertigo, headache, fatigue, sleep disturbances, depression, syncope. CV: Hypotension, congestive heart failure, bradycardia, severe tachycardia, peripheral edema, AV block. GI: Nausea, abdominal discomfort, constipation, elevated liver enzymes. Body as a Whole: Flushing, pulmonary edema, muscle fatigue, diaphoresis. Skin: Pruritus.

DIAGNOSTIC TEST INTERFERENCE

May cause false positive for urine screen detection of methadone.

INTERACTIONS

Drug: BETA-BLOCKERS increase risk of CHF, bradycardia, or heart block; significantly increased levels of digoxin and carbamazepine and toxicity; potentiates hypotensive effects of HYPOTENSIVE AGENTS; levels of lithium and cyclosporine may be increased, increasing their toxicity; calcium salts (IV) may antagonize verapamil effects. Food: Grapefruit juice may increase verapamil levels. Herbal: Hawthorne may have additive hypotensive effects. St. John’s wort may decrease efficacy.

PHARMACOKINETICS

Absorption: 90% absorbed, but only 25–30% reaches systemic circulation (first pass metabolism). Peak: 1–2 h PO; 4–8 h sustained release; 5 min IV. Distribution: Widely distributed, including CNS; crosses placenta; present in breast milk. Metabolism: In liver (CYP3A4). Elimination: 70% in urine; 16% in feces. Half-Life: 2–8 h.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Establish baseline data and periodically monitor BP and pulse with oral administration.
• Following IV infusion, instruct patient to remain in recumbent position for at least 1 h after dose is given to diminish subjective effects of transient asymptomatic hypotension that may accompany infusion.
• Monitor for AV block or excessive bradycardia when IV infusion is given concurrently with digitalis.
• Monitor I&O ratio during IV and early oral maintenance therapy. Renal impairment prolongs duration of action, increasing potential for toxicity and incidence of adverse effects. Advise patient to report gradual weight gain and evidence of edema.
• Monitor ECG continuously during IV administration. Essential because drug action may be prolonged and incidence of adverse reactions is highest during IV administration in older adults, patients with impaired kidney function, and patients of small stature.
• Check BP shortly before administration of next dose to evaluate degree of control during early treatment for hypertension.
• Montior lab tests: Baseline and periodic LFTs and kidney functions.

Patient & Family Education

• Monitor radial pulse before each dose, notify prescriber of an irregular pulse or one slower than established guideline.
• Do not drive or engage in potentially  hazardous activities until response to drug is known.
• Decrease intake of caffeinecontaining beverage (i.e., coffee, tea, chocolate).
• Change positions slowly from lying down to standing to prevent falls because of drug-related vertigo until tolerance to reduced BP is established.
• Notify prescriber of easy bruising, petechiae, unexplained bleeding.
• Do not use OTC drugs, especially aspirin, unless they are specifically prescribed by prescriber.

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Ditulis oleh Unknown pada tanggal Saturday, July 25, 2015