niCARdipine (Rx)
Generic: NiCARdipine
Brand: Cardene IV, Cardene SR
(nye- card'i- peen)
Pharmacological Action
Inhibits calcium ion influx across cell membrane during cardiac depolarization, produces relaxation of coronary vascular smooth muscle and peripheral vascular smooth muscle, dilates coronary arteries, increases myocardial oxygen delivery in patients with vaso- spastic angina
Therapeutic outcome: Decreased angina pectoris, decreased B/P in hypertension
Uses
Chronic stable angina pectoris, hypertension
Contraindications
Sick sinus syndrome, 2 nd- or 3 rd- degree heart block, hypersensitivity to this product or dihydropyridine, advanced aortic stenosis
Precautions: Pregnancy C, breastfeeding, children, geriatric, CHF, hypotension, hepatic injury, renal disease
Dosage & Routes
Hypertension
Adult: PO 20 mg tid initially; may increase after 3 days (range 20- 40 mg tid) or SUS REL 30 mg bid; may increase to 60 mg bid IV 5 mg/hr; may increase by 2.5 mg/hr q15 min; max 15 mg/hr Angina
Adult: PO 20 mg tid, may be adjusted q3 day, may use 20- 40 mg tid Renal dose
Adult: PO 20 mg tid or SUS REL 30 mg bid Hepatic dose
Adult: PO 20 mg bid
Available forms: Caps 20, 30 mg; sus rel caps 30, 45, 60 mg; inj 2.5 mg/ml, premixed 20 mg/200 ml, 40 mg/200 ml
Implementation PO route Do not break, crush, chew, or open sus rel caps Give without regard to meals Store in airtight container at room temperature IV route Dilute each 25 mg/240 ml of compatible sol (0.1 mg/ml), give slowly, titrate to patient's response, stable for 24 hr at room temperature, change IV site q30 min Solution compatibilities: D3 W, D5/0.45% NaCl, D5/0.9% NaCl
Y- site compatibilities: Alemtuzumab, amikacin, aminophylline, aztreonam, bivalirudin, butorphanol, calcium gluconate, CARBOplatin, caspofungin, ceFAZolin, ceftizoxime, chloramphenicol, cimetidine, CISplatin, clindamycin, cytarabine, DAPTOmycin, dexmedetomidine, diltiazem, DOBUTamine, DOCetaxel, DOPamine, DOXORubicin hydrochloride, enalaprilat, EPINEPHrine, epirubicin, erythromycin, esmolol, famotidine, fenoldopam, fentaNYL, gentamicin, hydrocortisone, HYDROMorphone, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mechlorethamine, methylPREDNISolone, metroNIDAZOLE, midazolam, milrinone, morphine, nafcillin, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, palonosetron, penicillin G potassium, potassium chloride/phosphate, quinupristin- dalfopristin, ranitidine, rocuronium, tacrolimus, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, vinCRISine, voriconazole, zoledronic acid Y- site incompatibilities: Amphotericin B liposome/lipid complex, ampicillin, ampicillin/sulbactam, cefepime, cefoperazone, ertapenem, fluorourecal, furosemide, methotrexate, micafungin, pantoprazole, PEMETrexed, thiopental, thiotepa, tigecycline
Adverse Effects
CNS: Headache, dizziness, anxiety, depression, confusion, paresthesia, somnolence, flushing
CV: Edema, bradycardia, hypotension, palpitations, pulmonary edema, chest pain, tachycardia, increased angina, arrhythmias, CHF
GI: Nausea, vomiting, gastric upset, constipation, hepatitis, abdominal cramps, dry mouth, sore throat
GU: Nocturia, polyuria
INTEG: Rash, infusion site discomfort, Stevens- Johnson syndrome
MISC: Blurred vision, flushing, sweating, SOB, impotence
Pharmacokinetics
Absorption: Well absorbed (PO); bioavailability poor
Distribution: Unknown
Metabolism: Liver, extensively
Excretion: Kidneys 60%, feces 35%
Half-life: 2-5 hr
Pharmacodynamics
PO: Onset ½ hr, Peak 1-2 hr, Duration 8 hr PO SUS
REL: Onset Unknown, Peak 2-6 hr, Duration 10-12 hr
Interactions
Individual drugs
Alcohol: increased hypotension CarBAMazepine, cycloSPORINE, prazosin, propranolol, quiNIDine: increased risk of toxicity
Cimetidine: increased niCARdipine effects Digoxin, quiNIDine, theophylline: increased effects
Rifampin: decreased antihypertensive effect
Drug classifications Antihypertensives, neuromuscular blocking agents, nitrates: increased hypotension
NSAIDs: decreased antihypertensive effect
Drug/herb Ginkgo, ginseng, hawthorn: increased effect Ephedra, melatonin, St. John's wort, yohimbe: decreased effect
Drug/food Grapefruit juice: increased hypotensive effect
Drug/lab test
Increased: LFTs
Decreased: potassium (IV), phosphate, platelets
Nursing Considerations
Assessment Assess fluid volume status (I&O ratio) and record weight, color, quality, and specific gravity of urine, skin turgor, adequacy of pulses, moist mucous membranes, bilateral lung sounds, peripheral pitting edema; dehydration symptoms of decreasing output, thirst, hypotension, dry mouth, and mucous membranes should be reported Monitor for
CHF: weight gain, crackles, jugular venous distention, dyspnea
Hyperpension: assess for decreasing B/P; salt in diet, smoking, exercise, diet, weight, monitor B/P often Assess anginal pain: intensity, location, duration, alleviating factors Monitor potassium, renal/liver function tests, periodically
Patient/family education Advise patient to avoid hazardous activities until stabilized on product and dizziness is no longer a problem Instruct patient to limit caffeine consumption; to avoid alcohol and OTC products unless directed by a prescriber, to take without regard to food, avoid high- fat foods, to swallow sus rel product whole
Hypertension: instruct patient to comply with all areas of medical regimen: diet, exercise, stress reduction, product therapy Instruct patient to notify prescriber of irregular heartbeat, shortness of breath, swelling of feet and hands, pronounced dizziness, constipation, nausea, hypotension, change in severity/pattern/incidence of angina Teach patient to use medication as directed even if feeling better; may be taken with other cardiovascular products (nitrates, β - blockers) Teach patient to take medication exactly as prescribed Advise patient to contact prescriber if anginal attacks continue or become worse
Evaluation
Positive therapeutic outcome: Decreased angina attacks, Decreased B/P TREATMENT OF
OVERDOSE: Defibrillation, atropine for AV block, vasopressor for hypotension
Reference
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