Mosby's 2014 Nursing Drug Reference (418 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(ver-ap′a-mill)
Apo-Verap
, Calan, Calan SR, Covera-HS, Isoptin SR, Nu-Verap, Verelan, Verelan PM
Func. class.:
Calcium channel blocker; antihypertensive; antianginal, antidysrhythmic (class IV)
Chem. class.:
Diphenylalkylamine
Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle; dilates coronary arteries; decreases SA/AV node conduction; dilates peripheral arteries
Chronic stable, vasospastic, unstable angina; dysrhythmias, hypertension, supraventricular tachycardia, atrial flutter or fibrillation
Unlabeled uses:
Prevention of migraine headaches, claudication, mania
Sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90 mm Hg systolic, cardiogenic shock, severe CHF, Lown-Ganong-Levine syndrome, Wolff-Parkinson-White syndrome
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, CHF, hypotension, hepatic injury, renal disease, concomitant β-blocker therapy
Calculator
• Adult:
PO
80-120 mg tid, increase weekly, max 480 mg/day
• Adult:
PO
240-480 mg/day in 3-4 divided doses in digitalized patients
• Adult:
IV BOL
5-10 mg (0.075-0.15 mg/kg) over 2 min, may repeat 10 mg (0.15 mg/kg) 1/2 hr after 1st dose
• Child 1-15 yr:
IV BOL
0.1-0.3 mg/kg over ≥2 min, repeat in 30 min, max 5 mg in single dose
• Child 0-1 yr:
IV BOL
0.1-0.2 mg/kg over ≥2 min, may repeat after 30 min
• Adult:
PO
80 mg tid, may titrate upward;
EXT REL
120-240 mg/day as single dose, may increase to 240-480 mg/day
• Adult:
PO
40 mg tid initially, increase as tolerated
• Adult:
PO
120-480 mg/day in divided doses
• Adult:
PO
160-320 mg/day in divided doses, may be given with lithium
• Adult:
PO
80 mg tid
Available forms:
Tabs 40, 80, 120 mg; ext rel tabs 120, 180, 240 mg; inj 2.5 mg/ml in ampules, syringes, vials; ext rel caps 100, 200, 240, 300 mg
•
Reg rel:
Give without regard to food
•
Do not crush or chew ext rel products; caps may be opened and contents sprinkled on food; do not dissolve chew cap contents
•
Before meals, at bedtime; give ext rel product with food
•
Undiluted through
Y
-tube or 3-way stopcock of compatible sol; give over 2 min or 3 min for geriatric patients, with continuous ECG and B/P monitoring, discard unused solution
•
Do not use IV with IV β-blockers, may cause AV nodal blockade
Y-site compatibilities:
Alfentanil, amikacin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefonicid, cefotaxime, cefoTEtan, cefOXitin, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, ciprofloxacin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin hydrochloride, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, ifosfamide, imipenem/cilastatin, inamrinone, insulin, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, papaverine, PEMEtrexed, penicillin G, pentamidine, pentazocine, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, rocuronium, sodium acetate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, ticarcillin/clavulanate, tirofiban, tobramycin, tolazoline, trimethaphan, urokinase, vancomycin, vasopressin, vecuronium, vinCRIStine, vinorelbine, voriconazole
CNS:
Headache, drowsiness
, dizziness, anxiety, depression, weakness, insomnia, confusion, lightheadedness, asthenia, fatigue
CV:
Edema
,
CHF,
bradycardia, hypotension, palpitations, AV block,
dysrhythmias
GI:
Nausea
, diarrhea, gastric upset,
constipation
, increased LFTs
GU:
Impotence, gynecomastia, nocturia, polyuria
HEMA:
Bruising, petechiae, bleeding
INTEG:
Rash, bruising
MISC:
Gingival hyperplasia
SYST:
Stevens-Johnson syndrome
Metabolized by liver, excreted in urine (70% as metabolites)
PO:
Onset variable; peak 3-4 hr; duration 17-24 hr; half-life (biphasic) 4 min, 3-7 hr (terminal)
IV:
Onset 3 min, peak 3-5 min, duration 10-20 min
Increase:
hypotension—prazosin, quiNIDine, fentaNYL, other antihypertensives, nitrates
Increase:
effects of verapamil—β-blockers, cimetidine, clarithromycin, erythromycin, monitor for CV effects
Increase:
levels of digoxin, theophylline, cycloSPORINE, carBAMazepine, nondepolarizing muscle relaxants
Decrease:
effects of lithium
Decrease:
antihypertensive effects—NSAIDs
Increase:
hypotensive effects—grapefruit juice
Increase:
verapamil effect—ginseng, ginkgo
Increase:
hypertension ephedra (ma huang)
Decrease:
verapamil effect—St. John’s wort
Increase:
AST, ALT, alk phos, BUN, creatinine, serum cholesterol
•
Cardiac status:
B/P, pulse, respiration, ECG intervals (PR, QRS, QT); notify prescriber if pulse <50 bpm, systolic B/P <90 mm Hg
CHF:
I&O ratios, weight daily; crackles, weight gain, dyspnea, jugular venous distention
•
Renal, hepatic studies during long-term treatment, serum potassium periodically
•
Therapeutic response: decreased anginal pain, decreased B/P, dysrhythmias
•
To increase fluids, fiber to counteract constipation
•
How to take pulse, B/P before taking product; to keep record or graph
•
To avoid hazardous activities until stabilized on product, dizziness no longer a problem
•
To limit caffeine consumption; to avoid alcohol products
•
To avoid OTC or grapefruit products unless directed by prescriber
•
To comply with all areas of medical regimen: diet, exercise, stress reduction, product therapy
•
To change positions slowly to prevent syncope
•
Not to discontinue abruptly, chest pain may occur
To report chest pain, palpitations, irregular heart beats, swelling of extremities, skin irritation, rash, tremors, weakness
•
To notify prescriber if pregnancy is planned; may breastfeed (American Academy of Pediatrics)
•
That cap (Covera-HS)
may appear in stool
Defibrillation, atropine for AV block, vasopressor for hypotension, IV calcium