Verapamil HCl Drug Study
In making a Drug Study, the following elements must be present:
Generic Name and the Brand name (not all brands, just the brand
used by the patient), Action, Indication, Pregnancy Category, Drug
Classification, and Contraindication, Adverse Effect, Drug
interaction and Nursing Consideration/Intervention. Most clinical
instructors preferred this to be in a long bond paper in printed or
handwritten with paper in landscape.
Verapamil hydrochloride
Brand Name: Calan, Calan SR, CoveraHS, Isoptin, Isoptin SR, Verelan, Verelan PM,
Pregnancy Category C
Drug classes: Calcium channelblocker, Antianginal agent, Antiarrhythmic, Antihypertensive
Therapeutic actions
Inhibits the movement of calcium ions across the membranes of cardiac and
arterial muscle cells; calcium is involved in the generation of the action
potential in specialized automatic and conducting cells in the heart, in
arterial smooth muscle, and in excitation-contraction coupling in cardiac
muscle cells; inhibition of transmembrane calcium flow results in the
depression of impulse formation in specialized cardiac pacemaker cells,
slowing of the velocity of conduction of the cardiac impulse, the depression
of myocardial contractility, and the dilation of coronary arteries and
arterioles and peripheral arterioles; these effects lead to decreased cardiac
work, decreased cardiac energy consumption, and in patients
with vasospastic (Prinzmetal's) angina, increased delivery of oxygen to
myocardial cells.
Indications
Angina pectoris due to coronary artery spasm (Prinzmetal's variant
angina)
Effort-associated angina
Chronic stable angina in patients who cannot tolerate or do not
respond to beta-adrenergic blockers or nitrates
Unstable, crescendo, preinfarction angina
Essential hypertension (sustained-release oral only)
Treatment of supraventricular tachyarrhythmias (parenteral)
Temporary control of rapid ventricular rate in atrial flutter
or atrial fibrillation (parenteral)
Unlabeled oral uses: paroxysmal supraventricular tachycardia,
migraine headache, nocturnal leg
cramps, hypertrophiccardiomyopathy
Contraindications
Contraindicated with allergy to verapamil; sick sinus syndrome,
except with ventricular pacemaker; heart block (second- or thirddegree); hypotension; pregnancy; lactation.
Use cautiously with
idiopathic hypertrophic subaorticstenosis, cardiogenic shock, severe
CHF, impaired renal or hepatic function, and in patients
with atrial flutter or atrial fibrillation and an accessory to bypass tract.
Adverse effects
Dizziness, vertigo, emotional depression, sleepiness, headache, Peripheral
edema, hypotension, arrhythmias, bradycardia; AV heart
block, Nausea, constipation, Muscle fatigue, diaphoresis, rash
Drug Interactions:
Increased cardiac depression with beta-adrenergic blocking agents
Additive effects of verapamil and digoxin to slow AV conduction
Increased serum levels of digoxin, carbamazepine, prazosin, quinidine
Increased respiratory depression
with atracurium, gallamine, pancuronium, rucuronium, tubocurarine, ve
curonium
Risk of serious cardiac effects with IV beta-adrenergic blocking
agents; do not give these drugs within 48 hr before or 24 hr after
IV verapamil
Decreased effects with calcium, rifampin
Nursing considerations
Monitor patient carefully (BP, cardiac rhythm, and output) while drug
is being titrated to therapeutic dose. Dosage may be increased more
rapidly in hospitalized patients under close supervision.
Ensure that patient swallows SR tablets whole: do not cut, crush, or
chew.
Monitor BP very carefully with concurrent doses of antihypertensives.
Monitor cardiac rhythm regularly during stabilization of dosage and
periodically during long-term therapy.
Administer sustained-release form in the morning with food to
decrease GI upset.
Protect IV solution from light.
Monitor patients with renal or hepatic impairment carefully for
possible drug accumulation and adverse reactions.
