NAME OF DRUG GENERIC NAME: Nifedipine TRADE NAME: Adalat CC, Adalat XL, Nifedical XL, Procardia CONTENT:

Nifedipine PATIENTS DOSE: 10 mg tab p.o. stat MINIMUM DOSE: 10 mg tid p.o. maintenance: 10-20 mg tid MAXIMUM DOSE: 20-30 mg tid AVAILABILITY: ER tablets30,60,90mg Capsules- 10,20 mg (should be protected from light, moisture, and humidity.)

CLASSIFICATION THERAPEUTIC: Anti-hypertensive, Anti-hypertensive PHARMACOLOGIC : -Calcium channel blocker -Antiarrhythmic -Vasodilator

PREGNANCY CATEGORY: C

MECHANISM OF ACTION Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, inhibition of transmembrane calcium flow results in the depression of impulse formation in specialized cardiac pacemaker cells, in slowing of the velocity of the conduction of the cardiac muscle impulse, in the depression of the of myocardial contractility and in the dilation of coronary arteries, arterioles. These effects lead to decreased cardiac work, decreased cardiac energy consumption, and increased delivery of oxygen to myocardial cells.

INDICATION > Angina Pectoris due to coronary artery spasm > angina > This effect can be used to correct abnormally rapid heartbeats > Treatment of hypertension > prevention of migraine headaches in adults >uses include anal fissures (applied to the fissures)

CONTRAINDICATION Contraindicated in patients who are allergic to nifedipine.

ADVERSE EFFECTS CNS: headache, asthenia, dizziness, fatigue, nervousness, sleep disturbances. CV: peripheral edema, angina, hypotension, arrhythmias, AV block, asystole

NURSING RESPONSIBILTIES
Before: > Assess the history of allergies to nifedipine and also pregnancy and lactation. >teach significant others of the patient the common side effects of the drug and to report any severe effects at once. > Ensure that patient does not chew or divide sustained-release of tablet. During: >perform rights of medication. >advise patient to drink medication as directed. > Monitor patients v/s and cardiac output carefully. >Monitor BP carefully during titration period. Patient may become severely hypotensive, especially if also taking other drugs known to lower BP. Withhold drug and notify physician if systolic BP <90. >Monitor blood sugar in diabetic patients. Nifedipine has diabetogenic properties. >Monitor for gingival hyperplasia and report promptly. This is a rare but serious adverse effect (similar to phenytoin-induced hyperplasia). After: >advise patient not to take more than prescribed. >document findings. Patient & Family Education >Inspect gums visually every day. Changes in gingivae may be gradual, and bleeding may be exhibited only with probing. >Seek prompt treatment for symptoms of gingival hyperplasia (easy bleeding of gingivae and gradual enlarging of gingival mass, especially on buccal side of lower anterior teeth). Drug will be discontinued if gingival hyperplasia occurs.

PRECAUTION: Use cautiously with patients who are lactating and pregnant.

Dermatologic: Flushing, rash, pruritus, dermatitis GI: nausea, Constipation, diarrhea, cramps, flatulence OTHER: nasal congestion, cough, fever, chills, shortness of breath, muscle cramps

SOURCE: Lippincots Nursing Drug Guide, 2009