CCB's-ATI Pharm

Question 1

CCI’s stand for

Answer 1

Calcium Channel Blockers

Question 2

Meds

Answer 2

Prototypes=Nifedipine,Verapamil,Diltiazem

• Amlodipine
• Felodipine
• Nicardipine

Question 3

Expected pharm action: Nifedipine

Answer 3

1-blocking of calcium channels in BV leads to vasodilation of vascular smooth muscle(peripheral arterioles) & arteries/arterioles of the heart
2-acts primarily on arterioles, veins aren’t significantly affected

Question 4

Expected pharm action=verapamil/diltiazem

Answer 4

1-blocking of calcium channels in BV leads to vasodilation of peripheral arterioles and arteries/arterioles of the heart
2-blocking of calcium channels in myocardium,SA and AV node leads to a decreased force of contraction, decreased HR,and slowing of rate conduction through AV node
3-these meds act on arterioles and heart at therapeutic doses,veins aren’t significantly affected

Question 5

Therapeutic uses: Nifedipine/Amlodipine/Nicardipine

Answer 5

1-angina pectoris

2-hypertension

Question 6

Therapeutic uses: Felodipine

Answer 6

Hypertension

Question 7

Therapeutic uses: verapamil/diltiazem

Answer 7

1-angina pectoris
2-hypertension
3-cardiac dysrhythmias(atrial fib,atrial flutter,SVT)

Question 8

Complications: Nifedipine

Answer 8

1-reflex tachycardia
2-acute toxicity
3-orthostatic hypotension and peripheral edema

Question 9

Reflex Tachycardia

Answer 9

1-monitor pts for increased HR

2-administer beta blocker(metoprolol) to counteract

Question 10

Acute toxicity

Answer 10

1-w/ excessive doses the heart in addition to BV is affected
2-monitor vital signs/ECG.Provide gastric lavage & cathartic if indicated
3-administer meds(norepinephrine,calcium isoproterenol,lidocaine&IV fluids)
4-have equipment for cardioversion and cardiac pacer available

Question 11

Orthostatic hypotension/peripheral edema

Answer 11

1-monitor BP/edema/daily weight
2-look for swelling in lower extremities
3-diuretic can be prescribed to control edema
4-instruct about manifestations of postural hypotension

Question 12

Complications:verapamil/diltiazem

Answer 12

1-orthostatic hypotension/peripheral edema
2-constipation(primarily verapamil)
3-suppression of cardiac function
4-dysryhthmias 
5-acute toxicity

Question 13

Suppression of cardiac function

Answer 13

-bradycardia,heart failure

1-monitor ECG,pulse rate,rhythm

Question 14

Dysrhythmias

Answer 14

QRS complex is widened and QT interval is prolonged

-monitor vital signs and ECG

Question 15

Acute toxicity

Answer 15

Resulting in hypotension,bradycardia,AV block,& ventricular tachydysrythmias
1-monitor vital signs/administer meds/have equipment

Question 16

Contraindications/Precautions

Answer 16

Pregnancy risk cat C
Nifedipine:
1-contraindicated in pts in cardiogenic shock
2-use with caution in pts who have acute MI,unstable angina,aortic stenosis,hypotension,sick sinus syndrome,& 2nd/3rd degree AV block
Verapamil:
1-contraindicated in pts who have hypotension,heart block,digoxin toxicity,severe heart failure, and during lactation
2-use cautiously in older adults and pts who have kidney or liver disorders,mild to moderate heart failure, or GERD

Question 17

Interactions: Nifedipine

Answer 17

1-beta blockers(metoprolol) that decrease reflex tachycardia;monitor for excessive heart slowing
2-cimetidine,ranitidine,and grapefruit juice=can lead to toxicity;monitor for indications of toxicity(lowBP,high HR,flushing)

Question 18

Interactions:Verapamil/Diltiazem

Answer 18

1-digoxin toxicity=increases digoxin levels;can cause an additive effect and intensify AV conduction suppression;monitor digoxin levels,vital signs for bradycardia,&manifestations of AV block(reduced ventricular rate)
2-beta blockers=heart failure,AV block,bradycardia;monitor ECG/HR and wait several hrs between admin of meds
3-Grapefruit juice=can lead to toxicity

Question 19

Nursing Administration

Answer 19

1-advise pts not to chew/crush sustained release tablets
2-IV admin of verapamil=slowly over 2-3 min
3-advise pts w/ angina to record pain freq/intensity/dur/location
4-teach pts to monitor BP and HR and keep record. Withhold meds if for pulse less than 50/min and systolic BP less than 90mmHg