Calcium Channel Blockers & I Heart Jeopardy Game Flashcards
recall the sites of Ca2+ action and the consequences of calcium channel block
calcium acts to help contraction in vascular smooth muscle, skeletal muscle, and in the heart.
the consequences of blocking the calcium channel in the cardiac muscle is a reduction in contractility throughout the heart and a decrease in sinus node pacemaker rate and in AV node conduction velocity
the consequences of blocking the calcium channels in vascular smooth muscle is vasodilation
no need to worry about skeletal muslce
verapamil: list the MOA, hemodynamic effects, therapeutic uses, ae’s.
hemodynamic effects: direct effects on the heart and blood vessels and reflex responses
MOA: block calcium channels in the blood vessels and in the heart.
therapeutic uses: angina pectoris, essential hypertension, cardiac dysrthymias.
ae’s: constipation, dizziness, facial flushing, headache, peripheral edema, gingival hyperplasia.
ae’s: cardiac: bradycardia in the SA node, partial or complete AV block in the AV node, decreased contractility in the myocardium.
what are the notable differences of verapamil compared to diltiazem?
verapamil causes more constipation than diltiazem,
how is nifedipine different from verapamil?
nifedipine produces very little blockade of calcium channels in the heart.
also note that nifedipine stimulates the baroreceptor reflex, unlike other CCBs.
list MOA, therapeutic uses and AE’s for nifedipine
MOA: blocks calcium channels in VSM and thereby promotes vasodilation
therapeutic uses: angina pectoris, hypertension
ae’s: flushing, dizziness, headache, peripheral edema, etc.
will NOT cause problems with AV block, heart failure, bradycardia, or sick sinus syndrome.
but reflex tachycardia is common so combine with a beta blocker for best results
for amlodIpIne, list the therapeutic uses and adverse effects
therapeutic uses: hypertensIon and angIna pectorIs
ae’s: flushing, dizziness, headache, eczematous rash.
little reflex tachycardia.
which medication stimulates the baroreceptor reflex and why?
nifedipine
quick vasodilation
recall the nursing implications for patients on calcium channel blockers
can give CCB’s orally or through IV.
CONTRAINDICATED in patients with severe hypotension, sick sinus syndrome, and second or third degree AV block.
*have patients swallow extended release capsules whole, without crushing or chewing.
IV therapy is only for people with cardiac dysrhythmias, and you need to give it slowly.
recall the nursing implications for CCB’s part two
minimizing AE’s:
cardiosuppresion: inform patients about the manifestations of cardiac effects (slow heartbeat, weight gain, SOB), and instruct them to notify the provider if these occur
peripheral edema: teach patients about signs (swelling), have them notify provider
constipation: advise patients that constipation can be minimized by increasing dietary fluid and fiber
minimizing DI’s
digoxin: combining digoxin with verapamil or diltiazem increases the risk for partial or complete AV block. Monitor for indications of impaired AV conduction (missed beats, slowed ventricular rate).
Verapamil can increase plasma levels of digoxin–>reduce digoxin dosage
Beta blockers: concurrent use of a beta blocker with verapamil or diltiazem can cause bradycardia, AV block, of heart failure. Monitor closely for cardiac suppression.
Administer intravenous verapamil and beta blockers several hours apart.
have them avoid grapefruit juice too bc it can result in toxicity.
managing acute toxicity:
remove unabsorbed drug with gastric lavage followed by activated charcoal
give IV calcium
give IV norepinephrine to raise BP
Bradycardia and AV block can be reversed with atropine and glucagon.
