Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (290 page)
(nye-fed′i-peen)
Adalat CC, Afeditab CR, Apo-Nifed
, Apo-Nifed PA, Nifediac CC, Nifedical XL, Procardia, Procardia XL
Func. class.:
Calcium channel blocker, antianginal, antihypertensive
Chem. class.:
Dihydropyridine
Do not confuse:
NIFEdipine
/niCARdipine/niMODipine
Inhibits calcium ion influx across cell membrane during cardiac depolarization; relaxes coronary vascular smooth muscle; dilates coronary arteries; increases myocardial oxygen delivery in patients with vasospastic angina; dilates peripheral arteries
Chronic stable angina pectoris, vasospastic angina, hypertension
Unlabeled uses:
Migraines, preterm labor, chronic/acute hypertension (pediatrics), diabetic nephropathy, proteinuria, hiccups
Hypersensitivity to this product or dihydropyridine; cardiogenic shock
Precautions:
Pregnancy (C), breastfeeding, children, CHF, hypotension, sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90 mm Hg systolic, hepatic injury, renal disease, acute MI, aortic stenosis, GERD, heart failure
Calculator
• Adult:
PO
Immediate release 10 mg tid, increase in 10-mg increments q7-14days, max 180 mg/24 hr or single dose of 30 mg;
SUS REL
30-60 mg/day, may increase q7-14days, max 90 mg/day
• Adult:
PO EXT REL
30-60 mg daily, titrate upward as needed, max 90 mg/day (Adalat CC), 120 mg/day (Procardia XL)
• Child/adolescent (unlabeled):
PO EXT REL
0.25-0.5 mg/kg/day, max 3 mg/kg/day
• Adolescent/child/infant:
PO
0.2-0.5 mg/kg/dose up to 10 mg (total dose)
• Adult:
PO
30-180 mg/day
• Pregnant female:
PO
Immediate release (Procardia, Adalat) 30-mg loading dose then 10-20 mg q4-6hr; use in monitored settings
Available forms:
Caps 5
, 10, 20 mg; ext rel tabs (CC, XL) 10, 20, 30, 60, 90 mg; tabs 10 mg
•
Do not break, crush, or chew ext rel tabs, do not use immediate release caps within 7 days of MI, coronary syndrome
•
Without regard to meals; avoid grapefruit juice
•
Protect caps from direct light, keep in dry area, do not freeze
CNS:
Headache
, fatigue, drowsiness,
dizziness
, anxiety, depression, weakness, insomnia, light-headedness, paresthesia, tinnitus, blurred vision, nervousness, tremor,
flushing
CV:
Dysrhythmias,
edema, hypotension, palpitations, tachycardia
GI:
Nausea, vomiting, diarrhea, gastric upset, constipation, increased LFTs, dry mouth, flatulence, gingival hyperplasia
GU:
Nocturia, polyuria
HEMA:
Bruising, bleeding, petechiae
INTEG:
Rash, pruritus, flushing, hair loss,
Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
MISC:
Sexual difficulties, cough, fever, chills
Metabolized by liver; excreted in urine 60%-80% (metabolites), feces 15%; protein binding 90%-98%
PO:
Onset 20 min, peak 0.5-6 hr, duration 6-8 hr, half-life 2-5 hr, well absorbed
PO-ER:
Duration 24 hr
Contraindicated with strong CYP3A4 inducers
Increase:
level of digoxin, phenytoin, cycloSPORINE, prazosin, carBAMazepine
Increase:
NIFEdipine, toxicity—cimetidine, ranitidine
Increase:
effects of β-blockers, antihypertensives
Decrease:
antihypertensive effect—NSAIDs
Decrease:
effects of quiNIDine
Decrease:
NIFEdipine level—smoking
Increase:
effect—ginkgo biloba, ginseng, hawthorn
Decrease:
effect—ephedra, melatonin, St. John’s wort, yohimbe
Increase:
NIFEdipine level—grapefruit juice
Increase:
CPK, LDH, AST
Positive:
ANA, direct Coombs’ test
•
Anginal pain:
location, intensity, duration, character, alleviating, aggravating factors
•
Cardiac status: B/P, pulse, respiration, ECG at baseline and periodically, in those taking antihypertensives, β-blockers, monitor B/P often
•
Potassium, renal, hepatic studies periodically during treatment
•
For bruising, petechiae, bleeding
•
GI obstruction:
Ext rel products have been associated with rare reports of obstruction in those with strictures and no known GI disease
•
Serious skin disorders:
rash that starts suddenly, fever, cutaneous lesions that may have pustules present; discontinue product
•
Therapeutic response: decreased anginal pain, B/P, activity tolerance
•
To avoid hazardous activities until stabilized on product, dizziness is no longer a problem
•
To limit caffeine consumption; to avoid alcohol products
•
To avoid OTC products unless directed by prescriber without regard to meals, Adelat CC should be taken on empty stomach
•
That empty tab shells may appear in stools and is not significant
•
Hypertension:
to comply with all areas of medical regimen: diet, exercise, stress reduction, product therapy
•
To change position slowly because orthostatic hypotension is common
To notify prescriber of dyspnea, edema of extremities, nausea, vomiting, severe ataxia, severe rash; changes in pattern, frequency, severity of angina
•
To increase fluid intake to prevent constipation
•
To check for gingival hyperplasia and report promptly
•
Not to discontinue abruptly; to gradually taper