Procardia Xl Case Study

1013 Words 5 Pages
PHA 6557
Assignment #4
Case 1
1. Procardia XL is also known as nifedipine, which belongs to a class of drugs called calcium channel blockers that prevent the transmembrane influx of calcium into both cardiac muscle and vascular smooth muscle. The formulation of nifedipine is an extended release tablet that is designed to provide a constant level of drug over a 24-hour period. Within the class of calcium channel blockers, nifedipine belongs to the dihydropyridine variety.
2. Dihydropyridines have a profound effect on the vascular tone by causing a decreased peripheral vascular resistance resulting in hypotension. In mild cases of overdose, a decrease in both systolic and diastolic blood pressure causes hypotension but the heart is spared due
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Due to the change in this patient’s status immediate interventions include: administration of crystalloid fluid bolus to help maintain blood pressure, administration of IV calcium gluconate to help improve contractility and hypotension, and atropine to block the parasympathetic nervous system and speed up the heart rate.
8. If the patients blood pressure does not improve the next step would be to administer a vasopressor to increase the heart rate and vessel tone by activating the sympathetic receptors found within the heart and vessels. High dose insulin therapy may also be utilized intravenously if the patient is hyperglycemic from the calcium channel blocker toxicity. It is imperative to monitor the patient’s blood glucose and administer glucose when needed to prevent insulin-induced hypoglycemia. Glucagon can also be administered intravenously in patients with refractory hypotension. If all of the above treatments have failed a phosphodiesterase inhibitor can be given to help improve conductivity in the heart.
9. In this case hemodialysis will be of little benefit because the nifedipine is highly protein bound at 92-98% and has a large volume of distribution. Only a small percentage of the free fraction of drug would be capable of passing through the dialysis membrane for clearance out of the body.
Case
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Metoprolol is classified as a beta1-selective adrenoceptor-blocking agent. These receptors are found within the heart and when activated cause increased heart rate and contractility. This drug is used for the treatment of hypertension. Blockade of the beta1 receptor results in decreased heart rate, myocardial contractility, myocardial oxygen consumption, and blood pressure. If is important to know whether or not this medication has an extended release formulation which can help the emergency room clinician make decisions about treatment and determine how long the child should be monitored.
3. Metoprolol succinate is available in an extended release formulation with tablets in 25 mg, 50 mg, 100 mg, and 200mg. This controlled release formulation of metoprolol allows for once a day administration. Metoprolol also comes in an immediate release tablet and an injectable form.
4. In beta-blocker overdose, children usually have minimal symptoms. Children are able to maintain blood pressure and cardiac function without sympathetic activity even at rest.
5. The most common effect of beta-blocker toxicity in children is hypoglycemia. A glucose test can be performed to rule out this side

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