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INTRODUCTION

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amlodipine (am-loe-di-peen)

Norvasc

Classification

Therapeutic: antihypertensives

Pharmacologic: calcium channel blockers

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Indications
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Alone or with other agents in the management of hypertension, angina pectoris, and vasospastic (Prinzmetal's) angina.

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Action
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Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Therapeutic Effects: Systemic vasodilation resulting in decreased blood pressure. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina.

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Adverse Reactions/Side Effects
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CNS: headache, dizziness, fatigue. CV: peripheral edema, angina, bradycardia, hypotension, palpitations. GI: gingival hyperplasia, nausea. Derm: flushing.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure periodically, and compare to normal values (see Appendix F) to help document antihypertensive effects.

  • Assess episodes of angina pectoris at rest and during exercise. Document whether drug therapy is helpful in reducing the frequency and severity of anginal attacks.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles due to peripheral vasodilation.

  • Assess dizziness and fatigue that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Design and implement aerobic exercise and endurance training programs to normalize blood pressure, improve coronary perfusion, reduce angina, and improve myocardial pumping ability.

  • Because of the risk of cardiac arrhythmias and angina pectoris, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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Patient/Client-Related Instruction
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  • Remind patients to take medication as directed to control hypertension and other cardiac conditions, even if they are asymptomatic.

  • Counsel patients about additional interventions to help control blood pressure and cardiac dysfunction, including regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.

  • Instruct patient or family/caregivers to report other troublesome side effects such as severe or prolonged headache, fatigue, nausea, or warmth/flushing of the skin.

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Pharmacokinetics
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Absorption: Well absorbed after oral administration (64–90%).

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Distribution: Probably crosses the placenta.

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Protein Binding: 95–98%.

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Metabolism and Excretion: Mostly metabolized by the liver.

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Half-life: 30–50 hr ...

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