Name the Potassium Channel Activators drug:
Nicorandil
Mechanism of Action:
Dual mechanism of action.
- Opens ATP- sensitive K+ channels resulting in smooth muscle relaxation, thereby promoting arterial vasodilation and reducing afterload.
- Nitric oxide moiety activates guanylyl cyclase to achieve venous relaxation and reduction in preload.
- Direct effects on coronary arteries are also seen.
Indications:
Prophylaxis and treatment of angina.
Cautions and Contra-Indications:
- Cardiogenic shock.
- Hypersensitivity
- Patients with shock (including cardiogenic shock)
- Severe hypotension or left ventricular dysfunction with low filling pressure or cardiac decompensation.
- Use of phosphodiesterase 5 inhibitors, since this can lead to a serious drop in blood pressure.
- Hypovolemia.
- Acute pulmonary oedema.
Nicorandil
| Nicorandil |
| Availability: Nicorandil 10 mg and 20 mg Tablets |
| Administration and handling: Nicorandil Tablets are administered by oral route. The tablets are to be swallowed in the morning and in the evening with a glass of water. The tablets should not be crushed or chewed. The tablet can be divided into equal doses. Administration is independent of food intake. |
| Angina: PO: The usual therapeutic range is 10 to 20 mg twice daily. The usual starting dose is 10 mg twice daily (bid), in the morning and in the evening preferably. It is recommended that the dose be titrated upwards in accordance with the patient’s needs, response and tolerance up to 40 mg twice daily, if necessary. A lower starting dose of 5 mg twice daily may be used in patients particularly prone to headache |
Side-Effects:
- Headache on initiation
- Nausea and vomiting
- Dizziness
- Flushing
- Weakness
- Oral ulceration
- Angioedema
Nursing Considerations
Baseline Assessment
- Presence of mentioned contraindications and cautions
- Skin color and integrity, and signs of hemorrhage.
- Cardiopulmonary status (BP; take heart rate in full minute)
- Electrocardiogram as ordered
- Laboratory tests (e.g. CBC, and electrolytes mainly)
- Record onset, type (sharp, dull, squeezing), radiation, location, intensity duration of anginal pain; precipitating factors (exertion, emotional stress).
- Receive full medication history, and screen for interactions, esp. use of PDE5 inhibitors.
Intervention/ Evaluation
- Monitor number of anginal episodes, orthostatic B/P.
- Monitor B/P, heart rate. Assess for facial, neck flushing.
- Assist with ambulation if light-headedness, dizziness occurs.
Patient Teaching:
- Nicorandil may cause you to feel faint or dizzy, particularly when you first start taking it. Do not drive and do not use tools or machines until you know how you react. It is best not to drink alcohol while you are on nicorandil, as alcohol will increase these feelings of dizziness.
- Watch for side-effects of the drug like headache, dizziness and persistent mouth and gastric ulcers. If any signs and symptoms are present, seek immediate medical attention.
- Do not abruptly stop the medication.
- Do not take more than the recommended dose unless your doctor tells you to.
Metabolism And Half-Life:
- T ½ is 40-80min. Metabolized by the liver via nicotinamide pathway.
- <20% excreted in the urine.
Drug Interactions:
- Hypotensive effects significantly enhanced when taken with phosphodiesterase type 5 inhibitors (sildenafil).
- Hypotensive effects possibly enhanced with tricyclic antidepressants and alcohol.
Important points:
- Start at a lower dose in patients susceptible to headaches.
- Patients are advised not to drive or operate machinery until it is established that their performance is unaffected. Titrate dose to symptomatic relief.
- Used as an add-on therapy.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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