Felodipine is a widely used calcium channel blocker prescribed to manage hypertension and angina pectoris. Nurses play a vital role in ensuring its safe administration, monitoring patient responses, and providing education to optimize therapeutic outcomes. This article provides a comprehensive guide to felodipine, focusing on key nursing considerations and practical management strategies.
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Introduction to Felodipine
Felodipine belongs to the dihydropyridine class of calcium channel blockers. It is primarily indicated for the treatment of high blood pressure (hypertension) and chest pain due to reduced blood flow to the heart (angina). By promoting vasodilation, felodipine reduces the workload on the heart and improves oxygen delivery to the myocardium. Nurses must understand its pharmacology, administration guidelines, and potential risks to deliver effective care.
Pharmacology
Felodipine works by inhibiting the influx of calcium ions into vascular smooth muscle cells, leading to relaxation of arterial blood vessels. This vasodilation decreases peripheral resistance, lowers blood pressure, and alleviates angina symptoms. As a long-acting agent, felodipine provides sustained effects, typically administered once daily. Its bioavailability can be affected by food and certain drug interactions, which nurses should be aware of during patient assessments.
Indications
- Hypertension: Primary use to control elevated blood pressure.
- Angina Pectoris: Relieves chest pain by improving coronary blood flow.
Dosage and Administration
- Hypertension:
- Adults: Initial dose of 5 mg once daily; titrate between 2.5–10 mg based on response.
- Elderly: Start at 2.5 mg once daily due to increased sensitivity.
- Administration Guidelines:
- Take orally, with or without food.
- Swallow tablets whole; do not crush or chew to preserve the extended-release formulation.
- Administer at the same time daily for consistency.
- Missed Dose: If remembered well before the next dose, take it; otherwise, skip and resume the regular schedule.
Side Effects and Adverse Reactions
Felodipine may cause a range of side effects, which nurses must monitor:
- Common:
- Headache
- Dizziness
- Peripheral edema (especially in the ankles)
- Flushing
- Serious:
- Hypotension
- Bradycardia
- Heart block
- Gingival hyperplasia (rare)
Prompt recognition and reporting of severe reactions are essential for patient safety.
Contraindications and Precautions
- Contraindications:
- Hypersensitivity to felodipine or other dihydropyridines
- Severe aortic stenosis
- Unstable angina or recent myocardial infarction
- Precautions:
- Use cautiously in patients with heart failure or hepatic impairment.
- Avoid abrupt discontinuation to prevent rebound hypertension.
Nursing Considerations
Nursing management of felodipine involves thorough assessment, targeted interventions, and ongoing monitoring.
Assessment
- Measure blood pressure (BP) and heart rate (HR) prior to administration to establish a baseline.
- Inspect for signs of peripheral edema, particularly in the lower extremities.
- Review the patient’s medication history for potential interactions, such as CYP3A4 inhibitors (e.g., ketoconazole, grapefruit juice), which increase felodipine levels.
Interventions
- Administer felodipine at a consistent time each day to maintain steady drug levels.
- Monitor for hypotension, especially after the first dose or dose increases; instruct patients to change positions slowly to prevent falls.
- Report symptoms of heart failure (e.g., dyspnea, weight gain) or worsening angina to the healthcare provider immediately.
- Ensure proper storage of the medication, away from moisture and heat.
Monitoring
- Regularly check BP and HR to evaluate therapeutic efficacy and detect adverse effects.
- Assess for gingival hyperplasia during long-term use and encourage good oral hygiene.
- Observe for signs of fluid retention or worsening cardiac symptoms.
Patient Education
Empowering patients with knowledge enhances adherence and safety. Nurses should teach patients to:
- Take felodipine exactly as prescribed and avoid stopping it suddenly.
- Avoid grapefruit juice, which can increase drug concentration and risk of side effects.
- Report symptoms such as dizziness, swelling, or irregular heartbeat promptly.
- Adopt a heart-healthy lifestyle, including a low-sodium diet, regular exercise, and stress management, to support treatment.
Special Considerations
- Elderly Patients: Initiate at a lower dose (2.5 mg) and monitor closely for orthostatic hypotension and falls.
- Renal Impairment: No dosage adjustment is typically required.
- Hepatic Impairment: Reduce the dose and monitor liver function, as felodipine is metabolized by the liver.
- Pregnancy and Lactation: Use only if benefits outweigh risks; consult the prescriber.
Conclusion
Felodipine is an effective treatment for hypertension and angina, but its success relies on diligent nursing care. Through careful assessment, precise administration, and comprehensive patient education, nurses can minimize risks and maximize benefits. Staying vigilant for side effects and tailoring interventions to individual patient needs ensures safe and effective management of felodipine therapy.
