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INTRODUCTION

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verapamil (ver-ap-a-mil)

Apo-Verap, Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Novo-Veramil, Nu-Verap, Verelan, Verelan PM

Classification

Therapeutic: antianginals, antiarrhythmics (class IV), antihypertensives, vascular headache suppressants

Pharmacologic: calcium channel blockers

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Indications
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Management of hypertension, angina pectoris, and/or vasospastic (Prinzmetal's) angina. Management of supraventricular arrhythmias and rapid ventricular rates in atrial flutter or fibrillation. Unlabeled Use: Prevention of migraine headache. Management of cardiomyopathy.

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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. ↓ SA and AV conduction and prolongs AV node refractory period in conduction tissue. Therapeutic Effects: Systemic vasodilation resulting in ↓ blood pressure. Coronary vasodilation resulting in ↓ frequency and severity of attacks of angina. Suppression of ventricular tachyarrhythmias.

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Adverse Reactions/Side Effects
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CNS: abnormal dreams, anxiety, confusion, dizziness/lightheadedness, drowsiness, headache, jitteriness, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea, shortness of breath. CV: ARRHYTHMIAS, CHF, bradycardia, chest pain, hypotension, palpitations, peripheral edema, syncope, tachycardia. GI: abnormal liver function studies, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting. GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency. Derm: dermatitis, erythema multiforme, flushing, increased sweating, photosensitivity, pruritus/urticaria, rash. Endo: gynecomastia, hyperglycemia. Hemat: anemia, leukopenia, thrombocytopenia. Metab: weight gain. MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.

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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). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

  • Monitor rashes or other skin reactions (hives, abnormal sweating, itching/burning, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).

  • Assess routinely for signs of CHF and pulmonary edema (dyspnea, cough, shortness of breath, rales/crackles, jugular venous distention). Report these signs to the physician.

  • 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.

  • If used to prevent migraine headaches, monitor the incidence and severity of attacks to document whether verapamil is successful in helping manage this condition.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to peripheral vasodilation.

  • Watch for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Insulin dosages may need to be adjusted ...

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