Lehne's Pharmacology CH 45
True
(T/F) The lowering of blood pressure and improvement of arterial blood flow to the heart counteract the negative effects of reduced heart rate and reduced force of contraction caused by verapamil.
Delirium
A nurse in an acute care facility is caring for a client who is receiving IV nitroprusside for hypertensive crisis. The nurse should monitor the client for which of the following adverse reactions to this medication?
Neutropenia
A nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following adverse effects of this medication?
Hydrochlorothiazide Clonidine Aliskiren
A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension?
Asthma
A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol?
Increase the amount of dietary fiber in the diet
A nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include?
Do not crush or chew tablet
A patient has been prescribed extended-release nifedipine. Teaching regarding administration should include which instruction?
Pulse 50 beats/min
A patient is prescribed diltiazem. It would be a priority to withhold the drug and contact the prescriber if which assessment finding was present?
Constipation, headache, and edema of the ankles and feet
A patient is prescribed verapamil [Calan]. The nurse should assess the patient for which common adverse effects?
The patient is in second-degree heart block.
A patient is to receive a scheduled dose of diltiazem [Cardizem]. The nurse should hold the medication and contact the prescriber if which of the following is noted?
Arrange for the patient to be transferred to a unit where constant monitoring of BP and ECG is possible
A patient on a surgical unit has been prescribed intravenous diltiazem for atrial fibrillation. What should the nurse do?
nausea and vomiting
A patient taking both verapamil and digoxin is at greater risk for digitalis toxicity. The nurse should assess and monitor the patient for early symptoms of digitalis toxicity, which include:
Sustained-release formulas of nifedipine cause a more gradual drop in BP
A patient who has experienced palpitations while taking nifedipine 20 mg three times a day has had his prescription changed to nifedipine 60 mg once a day. The patient asks the nurse how taking the same medication once a day instead of three times a day will help prevent palpitations. What should the nurse's response include?
Headache Edema of ankles and feet Overgrowth of gum tissue
A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication?
Blocks calcium channels in the heart and blood vessels (similar to verapamil) Lowers blood pressure
Actions and uses of Diltiazem [Cardizem, Dilacor-XR, Tiazac]
Similar to verapamil, except for less constipation Dizziness Flushing Headache Edema of ankles and feet Exacerbates bradycardia, sick sinus syndrome, heart failure, second- or third-degree heart block
Adverse effects of Diltiazem
Dihydropyridines
Agents that act mainly on vascular smooth muscle Significant blockade of calcium channels in blood vessels Minimal blockade of calcium channels in the heart Similar to verapamil in some respects and quite different in others
Verapamil and diltiazem
Agents that act on vascular smooth muscle and the heart
hypertension and angina pectoris
All CCB's promote vasodilation, and hence are useful in:
Blood pressure and ECG should be monitored Resuscitation equipment should be kept immediately available
Because IV verapamil for dysrhythmias can cause severe cardiovascular effects....
bradycardia, partial or complete AV block, and exacerbation of heart failure
Because of their cardiosuppressant effects, verapamil and diltiazem can cause:
dizziness, headache, and peripheral edema
Because they cause vasodilation, all CCBs can cause:
cardiac dysrhythmias, hypertension, angian pectoris
Because they suppress AV conduction, verapamil and diltiazem are useful for treating:
veins (venous system)
CCBs differ from nitrates in that they do not cause vasodilation of:
vasodilation
Calcium channel blockers lower blood pressure by:
Beta1
Calcium channel blockers work by reducing calcium influx into the cells of the heart and blood vessels. Calcium channels are coupled to which type of autonomic nervous system receptors?
Diltiazem
Classification of Benzothiazepine:
Nifedipine
Classification of Dihydropyridines:
Verapamil
Classification of Phenylalanine:
arterioles
Dihydropyridine CCBs primarily affect
the artieroles
Dihydropyridines act primarily on...
Limited to blockade of Ca channels in vascular smooth muscle (VSM)
Direct Effects of Nifedipine [Adalat, Nifedical, Nifediac, Procardia]
Digoxin Beta-adrenergic blocking agents
Drug interactions of Verapamil
Calcium channel blockers
Drugs that prevent calcium ions from entering cells Greatest impact on heart and blood vessels Used to treat hypertension, angina pectoris, and cardiac dysrhythmias Controversy: Safety for patients with hypertension and diabetes Also known as calcium antagonists and slow channel blockers
increases heart rate, AV conduction, and myocardial contractility
Effects of calcium on the heart
Nifedipine [Adalat, Nifedical, Nifediac, Procardia]
Examples of Dihydropyridines
increased mortality in patients with myocardial infarction and unstable angina
Immediate-release nifedipine has been associated with: The National Heart, Lung, and Blood Institute recommends that immediate-release nifedipine, especially in higher doses, be used with great caution, if at all
Apical pulse
In addition to assessing blood pressure, what is the priority assessment before administering diltiazem?
vasodilation
In blood vessels, calcium entry causes vasoconstriction, and hence calcium channel blockade causes:
beta1 receptors
In the heart, calcium channels are coupled to _____, activation of which enhances calcium entry calcium blockade and ____ blockade have identical effects on the heart
cardiosuppression, just like verapamil and diltiazem
In toxic doses, nifedipine and other dihydropyridines can cause:
Baroreceptor reflex
Indirect (reflex) hemodynamic effects of Verapamil and Diltiazem
eGFR32 mL/min
It would be a priority to assess for cardiac effects and toxicity in a patient who is receiving nifedipine if laboratory test results include:
Adverse Effect of Verapamil: Constipation
Most common complaint Results from blockade of calcium channels in smooth muscle of the intestine Especially severe for older adults Can be decreased by increasing dietary fiber and fluids
Little or no net effect on cardiac performance Vasodilation accompanied by reduced arterial pressure and increased coronary perfusion
Net effects of Verapamil and Diltiazem
reflex tachycardia
Nifedipine and other dihydropyridines can cause:
Dizziness Facial flushing Headache Edema of ankles and feet Gingival hyperplasia Heart block
Other adverse effects of Verapamil
Nifedipine
The drop in blood pressure is produced by the CCB activates baroreceptors and stimulates the sympathetic nervous system. Which of these CCBs is most likely to have the adverse effect of reflex tachycardia?
Monitor the patient's cardiac rhythm continuously
The health care provider prescribes sustained-release verapamil [Calan SR] to an 82-year-old patient who takes digoxin [Lanoxin] daily. Which action is most appropriate for the nurse to take?
Monitor electrocardiogram
The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention?
"The pill should be swallowed whole."
The nurse instructs a patient about taking nifedipine [Procardia XL]. Which statement made by the patient indicates an understanding of medication teaching?
Contact the pharmacy
The nurse is administering medications on a medical-surgical unit in a hospital. The medication administration record states that the patient should receive Cardizem LA 120 mg once a day. The patient's drug supply includes Cardizem SR. What should the nurse do?
Verelan PM produces maximal effects in the morning when most cardiac events occur
The nurse is administering the Verelan PM form of verapamil. The patient states she takes all of her medications in the morning when she awakens. The nurse's resonse should be based on what knowledge?
Consult the presciber
The nurse is caring for a patient who is scheduled to receive verapamil 180 mg and atenolol 50 mg at 0900. The patient has had a gastric tube inserted, and drugs are to be administered via the tube. Which action should the nurse take before administering these two drugs?
Crackles or pulmonary edema Shortness of breath Weight gain of 3 lb in 24 hours
The nurse is caring for a patient who is scheduled to receive verapamil and atenolol, a beta1 adrenergic blocker, at 0900. It is important for the nurse to assess for what critical adverse effects based on the combination of these two drugs before administration?
Peripheral vasodilation Coronary vasodilation
The nurse is caring for a patient with hypertension who is receiving verapamil [Calan]. The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug?
Atrial fibrillation
The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate?
"I will increase my intake of fluid and foods high in fiber." "I will call my healthcare provider if I notice swelling in my ankles."
The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective?
"I must make sure I swallow the pill whole."
The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication?
-ine
The suffix of the generic name of dihydropyridine CCBs is:
vasodilation reduced arterial pressure increased coronary perfusion
The three net effects of the CCBs verapamil and diltiazem on the heart are:
Angina pectoris Vasospastic angina and angina of effort Essential hypertension Second-line agent after thiazide diuretics Cardiac dysrhythmias Atrial flutter, atrial fibrillation, paroxysmal supraventricular tachycardia Migraine
Therapeutic Uses of Verapamil [Calan, Covera-HS, Isoptin, Verelan]
Selectively act on peripheral arterioles and arteries and arterioles of the heart No significant effect on veins
Therapeutic doses of calcium channel blockade
act primarily on VSM
Therapeutic use of nifedipine
Angina pectoris Hypertension Cardiac dysrhythmias
Therapeutic uses of Diltiazem
Severe hypotension Bradycardia and AV block Ventricular tachydysrhythmias Gastric lavage and activated charcoal
Toxicity of Verapamil
causes Vasoconstriction
Vascular smooth muscle: Calcium channels blocked..
causes contractile process
Vascular smooth muscle: Calcium channels open...
Nifedipine
Vasodilation by blocking calcium channels Blocks in vascular smooth muscle Very little blockade of heart calcium (Ca) channels Cannot be used to treat dysrhythmias Less likely than verapamil to exacerbate preexisting cardiac disorders
arterioles and the heart
Verapamil and diltiazem act on...
Notify the healthcare provider of nausea, vomiting, and visual changes.
What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]?
Erythematous, oozing vesicles on the chin and inside of elbows
Which dermatologic finding in an older adult would warrant consultation with the prescriber regarding administration of diltiazem?
Metoprolol Lopressor
Which drug might be prescribed to counteract the reflex tachycardia associated with administration of dihydropyridine CCB?
Weigh yourself daily at the same time each day. Notify the healthcare provider if a skin rash develops. Rise slowly from a lying to a sitting position.
Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation?
Diltiazem [Cardizem]
Which medication is most likely to cause the side effect of constipation?
suppress
beta blockers can be used to ______ reflex tachycardia caused by nifedipine and other dihydropyridines
calcium channels
gated pores in the cytoplasmic membrane that regulate calcium entry into cells
beta blockers
intensify cardiosuppression caused by verapamil and diltiazem
immediate-release formulations; sustained-release formulations
tachycardia is most intense with ________, and much less intense with _________
VSM; heart
verapamil and diltiazem act on ____ and _____