Amlod-2.5mg

 Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle.

 Indications Hypertension; chronic stable angina; vasospastic (Prinzmetal’s or variant) angina.

 Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block, except with a functioning pacemaker.

 Route/Dosage

ADULTS: PO 5 to 10 mg qd. ELDERLY: PO Initially 2.5 mg qd.

HEPATIC IMPAIRMENT PO Initially 2.5 mg qd.

 Interactions

Beta-blockers: May cause increased adverse cardiac effects as a result of myocardial depression. Fentanyl: Severe hypotension or increased fluid volume requirements have occurred with similar drug.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; peripheral edema; syncope; tachycardia; bradycardia; arrhythmias; ventricular asystoles. CNS: Headache; dizziness; lightheadedness; fatigue; lethargy; somnolence. DERM: Dermatitis; rash; pruritus; urticaria. GI: Nausea; abdominal discomfort; cramps; dyspepsia. RESP: Shortness of breath; dyspnea; wheezing. OTHER: Flushing; sexual difficulties; muscle cramps, pain or inflammation.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. CHF: Cautious use is required with this condition. Hepatic impairment: Cautious use is required.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Administer medication in morning.
• If patient has difficulty swallowing, crush tablets.
• Store in tightly closed container in cool location.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note any diabetes, liver disease, cardiac disease or sensitivity to calcium channel blockers.
• Monitor BP and pulse before administration.
• Review baseline ECG.
• Assess for signs of withdrawal syndrome. Abrupt withdrawal may cause increased frequency and duration of angina. Gradual tapering of dose is necessary.
• Assess patient for signs of CHF during therapy.
• If chest pain occurs, assess for location, intensity, duration, and radiation. Nitroglycerin preparations may be administered in conjunction with this medication.
• If drug is used with other calcium channel blockers or beta-blockers, observe for intensification of side effects.
• Withhold medication and notify physician if any of the following signs and symptoms occur: Sudden severe dyspnea; edema of hands and feet; changes in ECG (widened QRS, prolonged QT segments); pulse falls below 50 bpm.
• If the patient experiences chest pain not relieved by medication, continue medication and notify physician.

OVERDOSAGE: SIGNS & SYMPTOMS Nausea, weakness, dizziness, drowsiness, confusion, slurred speech, hypotension, bradycardia, second- or third-degree AV block

 Patient/Family Education

• Teach patient how to monitor pulse before taking medication. Tell patient not to take medication if pulse if < 50 bpm and to call physician.
• Explain to patient how to monitor BP daily.
• Instruct patient not to stop taking this medication suddenly because doing so can cause chest pain and MI.
• Teach patient importance of good oral hygiene and frequent visits to dentist while taking medication.
• Inform patient that frequent follow-up appointments with physician are important to adjust medication dosage.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient not to take otc medications without consulting physician.