This document discusses preeclampsia and gestational hypertension, conditions that occur during pregnancy involving high blood pressure. It also discusses nifedipine (Procardia), a calcium channel blocker prescribed to treat hypertension during pregnancy and postpartum. The key effects of nifedipine are relaxing blood vessels to increase blood flow and reduce blood pressure. Common side effects and drug interactions are presented. Guidelines are provided for monitoring patients on nifedipine during the postpartum period.

1. Brittney L Rhodes
MSNE 5356 Advanced Pharmacology
Lamar University

2.  Common problems during pregnancy and in
the postpartum period
 Both conditions occur after the 20th week of
pregnancy
 In women with previously normal blood pressures
 Preeclampsia-proteinuria is present (≥ 0.3g)

3.  Results from generalized vasospasm
 Etiology is unknown
 Peripheral vascular resistance increases
 Vasospasm occurs-decreases the diameter of
blood vessels
 Vasoconstriction decreases blood flow and
increases blood pressure

4.  Calcium channel blocker
 Prescribed to treat hypertension
 Affects the way calcium moves into the cells
of the heart and blood vessels
 Results in the relaxation of the blood vessels
 Increases the oxygen to the heart and
reduces the workload of the heart.

5.  Dizziness
 Flushing
 Weakness
 Swelling of
ankles/feet
 Joint pain
 Leg cramps
 Headache
Drowsiness
N/V/D
Constipation
Insomnia
Rash/itching
Frequent
urination
Warm feeling of
the skin

6.  Gingival Hyperplasia
 Reflex tachycardia
 Results from the stimulation of the
baroreceptors in response to an
acute drop in the blood pressure

7.  Phenytoin
 Decreases the effect of Nifedipine by 70%
 Gentamicin
 Nifedipine increases the effect of Gentamicin
 Magnesium Sulfate
 Can result in hypotension and neuromuscular
blockade due to pharmacodynamic synergism
 Grapefruit or Grapefruit Juice
 Increase the level of Nifedipine; toxicity can
occur
 Quinidine
 Affects the binding of Nifedipine

8. Conventional Extended Release
 Bioavailability: 40-
77%
 Onset: 20 minutes
 Duration: 8 hours
 Bioavailability: 65-
89%
 Onset: 30 minutes
 Duration: 24 hours

9.  Metabolized by the liver by CYP3A4
 Has a 2-7 hour half life
 Excreted through the urine (60-80%) and
feces (20-40%)
 Usual dosage: 30- 60 mg daily

10.  Nifedipine is transferred through breast milk
 Procardia XL- prescribed to breastfeeding
women
 Monitor patient closely
 Hold discharge on a postpartum unit
 Monitor the patient’s BP and for any adverse
reactions
 Monitor vital signs q4 hours

11.  Have patient record blood pressure BID
 Educate patient on potential side
effects/adverse reactions
 Encourage patient to avoid hazardous
activities
 Follow up with OB/GYN 1 week after
discharge

12.  Preeclampsia and gestational hypertension
normally resolve
 Within 6 weeks postpartum
 Patient usually stops taking Nifedipine
(Procardia)
 Chronic Hypertension is diagnosed
 if blood pressures remain high after the
postpartum period
 Further management is needed

13.  Arcangelo, V. P., & Peterson, A. M. (2013).
Pharmacotherapeutics for advanced practice: A practical
approach (3rd ed.). Ambler, PA: Lippincott, Williams &
 Cunha, J. (2015). Procardia. Retrieved from
http://www.rxlist.com/procardia-side-effects-drug-
center.htm
 Koley, A. P., Robinson, R. C., Markowitz, A., & Friedman, F.
K. (1997). Drug-drug interactions: Effect of quinidine on
nifedipine binding to human cytochrome P450 3A4 [].
Biochemical Pharmacology, 54(4), 455-460. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/9105395
 Murray, S. S., & McKinney, E. S. (2014). Foundations of
maternal-newborn and women’s health nursing (6th ed.).
St. Louis, MO:
 Nifedipine (oral route). (2015). Retrieved from
http:www/mayoclinic.org/drugs-supplements/nifedipine-
oral-route/description/drg-20071680