Exam 2: Calcium Channel Blockers

Question 1

Calcium Channel Blockers (CCB) block “L-Type” calcium channels in 3 areas. What are the 3 area’s?

Answer 1

-Vascular Smooth muslce

-Cardiac Myocytes

-Cardiac Nodal Tissue

Question 2

CCBs block L-type calcium channels in the cardiac myocytes. What effect does this have?

Answer 2

It lowers the strength of myocardial contractions

Question 3

CCBs block L-type calcium channels in the Vascular smooth muscle. What 2 locations does it specifically target?

Answer 3

Coronary and Peripheral arteries

Question 4

Calcium channels allow for Ca+ to enter through them and allow contractions to occur

If these Calcium channels are blocked by a CCB, the Ca+ cannot go through, so instead of a contraction you have what?

Answer 4

Relaxation/Dilation

Question 5

If a CCB causes a decreased Systemic Vascular Resistance, what effect does this have on Afterload?

Answer 5

It decreases afterload

Question 6

Vasodilation of the smooth muscles, means vasodilation of what 2 things?

What does this vasodilation cause?

Answer 6

Peripheral and coronary arteries

This causes increased blood flow to the heart muscles, like the myocytes

Question 7

What diseases are CCBs good for?

Answer 7

HTN and Angina

Question 8

Cardiac Myocytes are directly involved with the “blank” of heart contractions.

Answer 8

Involved in the strength of heart contractions

Question 9

How are CCBs beneficial in a patient who needs to decrease the O2 demand of the heart?

Answer 9

CCBs dilate peripheral and coronary arteries which allow easier flow of blood in/out of the heart.

Then, it decreases the overall strength of the heart contractions, which lowers the amount of O2 demand the heart needs to pump blood.

Question 10

Are CCBs good for heart failure?

Answer 10

NO!!!!!!!!!!!!!!!!!!!!!

Calcium Channel Blockers are NOT GOOD for heart failure patients

Question 11

Think of CCBs as a constant decrease on heart work. CCBs DECREASE constriction, and they DECREASE heart contractions.

Assuming that CCBs effects are to DECREASE, what would you assume is their effect on the SA/AV nodes? What does this effect do?

Answer 11

CCBs DECREASE the SA/AV node effects.

This lowers the heart rate (SA) and the speed of conduction of the electrical impulses (AV)

Question 12

Are CCBs helpful in treating dysrhythmias?

Answer 12

Yes!
CCBs lower the strength of contractions and lower the heart rate and electrical impulses sent by the SA/AV nodes, which can fix dysrhythmias

Question 13

What is an example of a dysrhythmia that a CCB can fix?

Answer 13

Atrial Fibrilation

Question 14

There are 2 types of CCBs: Dihydropyridines, and Non-dihydropyridines. One is Vascular selective, meaning they only work with vascular smooth muscle, and the other is myocardium selective, meaning they work with the myocardium. Which is which?

Answer 14

Dihydropyridines are vascular selective

Non-dihydropyridines are myocardium selective

Question 15

Which of these CCBs are Dihydropyridines, and which are Non-dihydropyridines?

-Verapamil
-Amlodipine
-Diltiazem
-Felodipine
-Nifedipine

Answer 15

Dihydropyridines are most common for CCB’s, and end in “pine”
-Amlodipine
-Felodipine
-Nifedipine

Non-dihydropyridines are:
Diltiazem
Verapamil

Question 16

between the vascular selective CCBs, and the myocardium selective CCBs, which one is best for:

-HTN
-Increased BP
-Angina
-Dysrhythmias

Answer 16

Vascular selective Dihydropyridines are best for HTN and decreasing overall BP

Myocardium selective non-dihydropyridines are best for Angina and Dysrhythmias

Question 17

A reason why Vascular selective Dihydropyridines are used for HTN and BP is that they really only affect the peripheral and coronary arteries.

While myocardium selective non-dihydropteroates aren’t used is because they can also have a negative effect on “blank” motility

Answer 17

GI motility

Question 18

What are two other afflictions (besides those involving the heart) that CCBs can be used to treat?

Answer 18

Raynaud’s, and Migraines

Question 19

What negative symptom should you monitor for in a patient taking Myocardium selective CCBs?

What about Vascular selective?

Answer 19

Bradycardia in myocardium selective

Hypotension in vascular selective

Question 20

What are some s/s of heart failure in a patient taking CCBs?

Answer 20

-Dyspnea: patient is winded from basic ADL

-Weight gain: Fluid retention leading to an increase in 2+ pounds of weight gained a day

-Edema: Especially in the legs

Question 21

Should you take CCBs with grape juice?

Answer 21

NOOOO!!!!!

Question 22

What is another HTN med that you shouldn’t take with grape juice?

Answer 22

ACE inhibitors

Question 23

Taking the myocardium selective CCB “Verapamil” can cause a decrease in your GI motility, and a vascular selective CCB like amlodipine, or felodipine, can enlarge your gums.

What are some things you would teach the patient to do to fight these effects?

Answer 23

For myocardium selective CCBs, eat a diet high in fiber to counteract the decrease in GI motility.

For Vascular selective, “pines” enlarge the gums, so keep up on oral care

Question 24

Taking a CCB along with the drug “Digoxin” can lead to toxicity.

What are some s/s of Digoxin toxicity?

Answer 24

Digoxin levels above 2ng/mL (0.5-2)

-N/V
-Vision changes like yellow-greenish halo’s
-Dysrhythmias

Question 25

Your patient is prescribed a calcium channel blocker. As the nurse you know that these medication works to block calcium channels in what areas of the body? Select all that apply:

A. Vagal nerve cells
B. Vascular smooth muscle
C. Cardiac nodal tissue
D. Peripheral nervous cells
E. Cardiac myocytes

Answer 25

The answers are B, C, and E. Calcium channel blockers work to block the L-type calcium channels in the vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue. When the calcium channels of these areas are blocked they will decrease contraction of these cells, which will provide vasodilation, decrease in heart rate, and decrease in strength of heart contractions. Remember there are different types of calcium channel blockers, and some are more selective to the vascular smooth muscle, while some are more selective to the myocardium.

Question 26

A patient is prescribed Verapamil for treatment of a supraventricular arrhythmia. As the nurse you know that this calcium channel blocker will help control the heart rate and rhythm by causing which of the following changes in the heart? Select all that apply:

A. Negative inotropic effect
B. Positive inotropic effect
C. Negative chronotropic effect
D. Positive chronotropic effect
E. Negative dromotropic effect
F. Positive dromotropic effect

Answer 26

The answers are A, C, and E. Verapamil is a calcium channel blocker that is a non-dihydropyridine (phenylalkylamine). It decreases the contractility of the heart muscle cells, which decreases the strength of heart contractions, and this causes a NEGATIVE inotropic effect. In addition, Verapamil decreases the contraction of nodal tissue cells, specifically the SA and AV nodal tissue. Therefore, by decreasing the SA node (pacemaker of the heart), the heart rate will decrease, and this causes a NEGATIVE chronotropic effect. And by decreasing the AV node (gatekeeper), the speed of conduction will decrease, which will cause a NEGATIVE dromotropic effect.

Question 27

Which type of calcium channel blockers below are considered non-dihydropyridines and can provide anti-arrhythmic effects? Select all that apply:

A. Nifedipine
B. Diltiazem
C. Amlodipine
D. Verapamil

Answer 27

The answers are B and D. Verapamil and Diltiazem are calcium channel blockers that are non-dihydropyridine. They are more selective to the myocardium when compared to dihydropyridine (Nifedipine and Amlodipine), which are more selective to the vascular system. Therefore, non-dihydropyridines can provide anti-arrhythmic effects.

Question 28

A patient is prescribed Diltiazem for the treatment of a cardiac disorder. Which findings below would require the nurse to hold the ordered dose of Diltiazem and notify the physician for further orders? Select all that apply:

A. Blood pressure 198/102
B. EKG shows 3rd Degree Atrioventricular Block
C. EKG shows Atrial Fibrillation with Rapid Ventricular Response
D. Heart Rate 46 beats per minute

Answer 28

The answers are B and D. Diltiazem is a calcium channel blocker that helps treat arrhythmias (supraventricular tachycardia and atrial fibrillation), hypertension, and angina. It is contraindicated if bradycardia or 2nd/3rd AV blocks occur. This is because this medication decreases the function of the SA and AV nodes (which is advantageous if a-fib with rapid ventricular response is occurring). However, if a 2nd degree AV block is presenting or bradycardia, the SA and AV nodes are not working properly and this medication could further impede their function.

Question 29

Which calcium channel blockers below are known as the dihydropyridines and are known to be more vascular selective? Select all that apply:

A. Verapamil
B. Felodipine
C. Nifedipine
D. Diltiazem
E. Amlodipine

Answer 29

The answers are B, C, and E. Remember the “dipine” medications are known as the dihydropyridines, and they are more vascular selective. This is why they are great at treating hypertension because they cause vasodilation due to inhibiting the calcium channels in the vascular smooth muscle. This leads to the relaxation of these vessels and in turn decreases arterial blood pressure.

Question 30

You’re providing discharge instructions to a patient who will be taking a calcium channel blocker at home. Which statement by the patient demonstrates they did NOT understand the teaching instructions and needs re-education?

A. “I will follow a low-fat and high-fiber diet.”
B. “I will limit my consumption of soft drinks and try to incorporate more healthy options, like grapefruit juice.”
C. “This medication can enlarge my gums so I will maintain good oral hygiene.”
D. “I will monitor my blood pressure regularly because this medication can cause low blood pressure.”

Answer 30

The answer is B. The patient should AVOID grapefruit juice while taking CCBs because this could lead to an increase in drug levels. The patient should follow a high-fiber diet due to constipation (especially with Verapamil). In addition, CCBs can enlarge the gums (gingival hyperplasia) and lower blood pressure.

Question 31

Your patient is taking Verapamil. When helping the patient make a lunch selection, the nurse should encourage the patient to choose items that are?

A. Low in calcium
B. High in fiber
C. Low in potassium
D. High in sodium

Answer 31

The answer is B. Verapamil can cause constipation. The patient should choose to eat foods that are high in fiber to help prevent this side effect.

Question 32

A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of these medications and to immediately notify the physician? Select all that apply:

A. The patient reports seeing yellow-greenish halos and is vomiting.
B. The patient reports flushing and has enlargement of the gums.
C. The patient’s heart rate is regular and 80 beats per minute.
D. The patient’s Digoxin level is 3 ng/mL.

Answer 32

The answers are A and D. Calcium channel blockers can increase Digoxin level. Therefore, the patient’s Digoxin levels should be monitored closely. A normal Digoxin level is 0.5-2 ng/mL. Signs and symptoms of Digoxin Toxicity is nausea, vomiting, vision changes (seeing yellowish/green halos, blurred vision etc. Option B is an expected side effect from calcium channel blockers and option C is normal.