Amlodipine besylate

Question 1

Alternate Name and Cost

Answer 1

Norvasc 4 - 40$

Question 2

Drug Class

Answer 2

Pharm: Dihydropyridine Calcium Entry Blocker
Therapeutic: Antihypertensives, antianginal (classical and variant)

Question 3

Pharmacodynamics

Answer 3

Reduces BP by inhibiting influx of calcium through “slow channels”, thereby dilating peripheral arterioles; also produces negative inotropic effect as well in myocardial cells; for angina, reduces afterload, thus decreasing oxygen consumption, also inhibits spasm of coronary arteries in vasospastic angina

Question 4

Pharmacokinetics

Answer 4

F 64-90%; peak effects 6-12 hours post dose; duration 24 hours, extensively metabolized in liver 90% excreted in urine as inactive metabolites

Question 5

Toxicity

Answer 5

Hypotension, AV block, worsening CHF, bradycardia, headache, edema; watch out in patients with aortic stenosis, heart failure, severe liver disease

Question 6

Interactions

Answer 6

Additive effects with most other antihypertensives; additive toxic effects on heart when given with beta-blockers (negative inotropic and dromotropic effects)

Question 7

Special Considerations

Answer 7

Shorter acting nifedipine (and similar CEBs) can increase risk of MI (unclear why); pregnancy C

Question 8

Indications and Dose / Route

Answer 8

2.5 up to 10 mg daily

Question 9

Monitor

Answer 9

Weight, edema, BP