class IV Antidysrhythmic Drugs (Calcium Channel Blockers)
Which statements are most appropriate when teaching about the management of calcium channel blockers' side effects? "Limit your intake of alcohol and tobacco." "Drink up to eight glasses of water to avoid constipation." "Take your pulse daily and hold the medication if your heart rate is above 80 bpm." "Take your blood pressure daily and hold the medication if it is above 140/80."
"Drink up to eight glasses of water to avoid constipation." Constipation is a common side effect of verapamil. Encourage fluid intake of up to eight glasses per day as appropriate.
When administering oral diltiazem to a patient, the nurse would expect to note a therapeutic response in what time frame? 1-2 minutes 15-20 minutes 1-3 hours 4-6 hours
1-3 hours The onset of action for oral diltiazem is 30-60 minutes, with peak plasma concentration occurring in 1-3 hours. This would be the expected time frame to note a therapeutic effect.
A patient taking diltiazem is complaining of dizziness. What should the assessment of this patient include? Select all that apply. Brain imaging A chest x-ray A 12-lead ECG The patient's blood pressure The patient's food and drug history The patient history regarding postural changes
A 12-lead ECG The patient's blood pressure The patient's food and drug history The patient history regarding postural changes
Upon discharge from the hospital, a patient is ordered to take a calcium channel blocker in a sustained-release form. What teaching should be included for this patient? Select all that apply. Take the medication with food or milk. A wax matrix may be visible in your stool. Do not split or crush or chew a sustained-release formulation. Fluid intake should be limited to no more than 1200 ml per day. Monitor your heart rate and blood pressure and report a slow heart rate and low blood pressure to your health care provider.
A wax matrix may be visible in your stool. Do not split or crush or chew a sustained-release formulation. Monitor your heart rate and blood pressure and report a slow heart rate and low blood pressure to your health care provider.
Which are common adverse reactions related to calcium channel blockers? Select all that apply. Nausea Skin rash Ankle edema Constipation Facial flushing
Ankle edema Constipation Facial flushing Adverse effects include constipation, bradycardia, heart block, hypotension, dizziness, dyspnea, facial flushing, headache, and edema of the ankles and feet.
A patient asks the nurse what diltiazem is prescribed for. The nurse responds that diltiazem is indicated for treatment of which dysrhythmia? Select all that apply. Atrial flutter Atrial fibrillation Ventricular tachycardia Supraventricular tachycardia Multi-focal premature ventricular contractions
Atrial flutter Atrial fibrillation Supraventricular tachycardia
How do calcium channel blockers inhibit the transport of calcium in the heart? Calcium channel blockers inhibit calcium influx into vascular smooth muscle only. Calcium channel blockers inhibit calcium transport into the ventricular tissues of the heart. Calcium channel blockers inhibit the influx of calcium into cardiac muscle by allowing the controlled delivery of calcium into cardiac cells. Calcium channel blockers are calcium ion channel antagonists, which prevent calcium from entering cells of the heart and blood vessel walls.
Calcium channel blockers are calcium ion channel antagonists, which prevent calcium from entering cells of the heart and blood vessel walls.
William Allen, a 73-year-old patient with a history of mitral valve regurgitation was admitted to the hospital with chest pain. His ECG showed atrial fibrillation at a rate of 140 beats per minute. He was initially treated with intravenous verapamil 5mg IV push x 2 before he converted to sinus rhythm with a rate of 86. To prevent further dysrhythmias, Mr. Allen is prescribed verapamil 80 mg po TID. The nurse's assessment indicates Mr. Allen has no more chest pain. His lungs are clear and his abdomen is soft. He has 1+ edema to his ankles and feet bilaterally. Mr. Allen's vital signs are as follows: BP 124/66, HR 56, R 20, and T 97.8 F. Mr. Allen is going to be discharged with oral verapamil. What should the nurse teach him about this medication? Select all that apply. Take verapamil on an empty stomach. Check his pulse before taking verapamil. Constipation is a common side effect of verapamil. Verapamil may cause hypertension and tachycardia. Do not drink grapefruit juice while taking verapamil.
Check his pulse before taking verapamil. Constipation is a common side effect of verapamil. Do not drink grapefruit juice while taking verapamil
Which statement(s) correctly explain why the nurse should closely monitor the liver status of an 80 year-old patient on diltiazem? Diltiazem is nephrotoxic Diltiazem is exclusively excreted by the kidneys. Diltiazem administration is contraindicated in the elderly. Diltiazem dose would need to be reduced in a patient with hepatic impairment.
Diltiazem dose would need to be reduced in a patient with hepatic impairment. Diltiazem is extensively metabolized by the liver. Hepatic impairment would lead to increased serum levels and potential toxicity.
A patient taking diltiazem and digoxin has elevated digoxin levels and missed her appointment to obtain lab draws. How should interactions between the two drugs be explained and the rationale for monitoring blood levels? Digoxin may cause a significant increase in the serum concentration of diltiazem. Diltiazem may cause a significant increase in the serum concentration of digoxin. Digoxin may cause a significant decrease in the serum concentration of diltiazem. Diltiazem may cause a significant decrease in the serum concentration of digoxin.
Diltiazem may cause a significant increase in the serum concentration of digoxin. When diltiazem and digoxin are taken together, your body may not process digoxin properly. The result of this interaction is an increase in the level of digoxin in the blood. Patients taking both diltiazem and digoxin will need dose adjustments and/or or special tests in order to safely take the medications together.
A health care provider routinely orders verapamil 360 mg per day in divided doses for the prevention of paroxysmal supraventricular tachycardia. Why would the nurse question this order for a patient with a history of liver cirrhosis? Verapamil is routinely administered as a once daily dose. The dose of 360 mg is not a standard daily dosage of verapamil. Verapamil is not indicated for the prevention of paroxysmal supraventricular tachycardia. Doses of verapamil must be substantially reduced in patients with hepatic impairment.
Doses of verapamil must be substantially reduced in patients with hepatic impairment. Because verapamil is eliminated by the liver, doses must be reduced substantially in patients with hepatic impairment.
Why do most calcium channel blockers have low and variable oral bioavailability? Due to rapid excretion from the kidneys. Due to extensive first-pass metabolism in the liver. Because of degradation of the drugs in the intestine. Because of the action of enzymes in the gastrointestinal lumen.
Due to extensive first-pass metabolism in the liver. Following oral administration, calcium channel blockers undergo extensive metabolism on the first pass through the liver, resulting in a reduced amount of medication reaching the systemic circulation.
Which symptoms should patients taking calcium channel blockers be instructed to report to their health care provider? Select all that apply. Edema Headache Facial flushing Shortness of breath Pronounced dizziness
Edema Shortness of breath Pronounced dizziness
Patients taking calcium channel blockers should be instructed to avoid which beverages? Select all that apply. Milk Orange juice Grapefruit juice Alcoholic beverages Caffeinated beverages
Grapefruit juice Alcoholic beverages Caffeinated beverages
Mr. Allen, a 73-year-old patient with a history of mitral valve regurgitation, was admitted to the hospital with chest pain. His ECG showed atrial fibrillation at a rate of 140 beats per minute. He was initially treated with intravenous verapamil 5 mg IV push x 2 before he converted to sinus rhythm with a rate of 86. To prevent further dysrhythmias, Mr. Allen is prescribed verapamil 80 mg PO TID. The nurse's assessment indicates Mr. Allen has no more chest pain. His lungs are clear, and his abdomen is soft. He has 1+ edema to his ankles and feet bilaterally. Mr. Allen's vital signs are as follows: BP 124/66, HR 56, R 20, and T 97.8 F. The nurse confirms Mr. Allen's heart rate is 56. What action should the nurse take with regard to the administration of verapamil? Administer the medication as ordered. Administer half the ordered dose of verapamil. Hold the medication and contact the prescriber. Administer the medication and recheck the heart rate in 30 minutes.
Hold the medication and contact the prescriber. The nurse should notify the prescriber of the low heart rate because the medication dose may need to be adjusted.
A patient with new-onset atrial fibrillation receives diltiazem intravenously. How does diltiazem temporarily slow the ventricular response to atrial fibrillation? It slows the conduction of impulses through the AV node. It decreases the excitability and contractility of the myocardium. It slows the ventricular response to atrial fibrillation through vasodilation. It enhances the influx of calcium ions into the calcium channels in cardiac conduction tissue.
It slows the conduction of impulses through the AV node. In atrial fibrillation and atrial flutter, diltiazem delays AV nodal conduction of impulses received from the atria; thereby, preventing the ventricles from beating as fast as the atria.
Verapamil is contraindicated for a patient with sick sinus syndrome. Which statements most accurately describe a potential adverse effect of verapamil on the sinoatrial node of the heart? May cause premature contraction of the atria May interfere with sinus-node impulse generation May increase the excitability of the sinoatrial node May decrease velocity of conduction at the sinoatrial node
May interfere with sinus-node impulse generation Verapamil may interfere with sinus-node impulse generation and thus induce sinus arrest or sinoatrial block in a patient with sick sinus syndrome.
What are the routes of administration for verapamil? Select all that apply. Oral Buccal Vaginal Intravenous Intramuscular
Oral Intravenous
Blockade of calcium channels by verapamil and diltiazem include which effects on cardiac tissue? Select all that apply. Reduction of myocardial contractility Enhancement of myocardial contractility Slowing of sinoatrial (SA) node automaticity Delay of atrioventricular (AV) nodal conduction Acceleration of atrioventricular (AV) nodal conduction
Reduction of myocardial contractility Slowing of sinoatrial (SA) node automaticity Delay of atrioventricular (AV) nodal conduction
Which is appropriate treatment for calcium channel blocker overdose? Secure patient's airway; administer fluids and norepinephrine; administer intravenous calcium Secure patient's airway; administer fluids and norepinephrine; administer intravenous atropine or glucagon Administer fluids and norepinephrine; administer intravenous atropine or glucagon; administer intravenous calcium Secure patient's airway; administer fluids and norepinephrine; administer intravenous atropine or glucagon; administer intravenous calcium
Secure patient's airway; administer fluids and norepinephrine; administer intravenous atropine or glucagon; administer intravenous calcium Securing the patient's airway is the priority intervention. Treatment of toxic effects may include: administering fluids and a vasoconstrictor to treat hypotension, atropine or glucagon to increase the heart rate, and intravenous calcium to counteract vasodilation and impaired contractility.
For which reasons would a nurse withhold a scheduled dose of diltiazem or verapamil? Select all that apply. Angina Atrial fibrillation Severe hypotension Essential hypertension Third-degree AV block
Severe hypotension Third-degree AV block
Calcium channel blockers are contraindicated for patients with which conditions? Select all that apply. Angina Bradycardia Sick-sinus syndrome Third-degree heart block Supraventricular tachycardia
Sick-sinus syndrome Third-degree heart block
A patient with paroxysmal supraventricular tachycardia is to receive 5 mg of verapamil intravenously. How does the nurse administer the dose? Slow injection Rapid injection Slow infusion over 24 hours The drug is not given intravenously
Slow injection Verapamil injected intravenously should be administered slowly over a few minutes. The patient's vital signs and heart rhythm are closely monitored during and after administration.
For which condition are the most common calcium channel blockers verapamil and diltiazem used? Heart failure Essential hypertension Third-degree heart block Supraventricular tachyarrhythmias
Supraventricular tachyarrhythmias Because of their effect on cardiac tissue, verapamil and diltiazem are the calcium channel blockers used for the treatment of supraventricular tachycardia, atrial fibrillation, and atrial flutter.
Calcium channel blockers are used to treat which cardiovascular condition? Heart failure Myocardial infarction Third-degree heart block Supraventricular tachycardia
Supraventricular tachycardia Calcium channel blockers are used to prevent, treat, or improve symptoms in high blood pressure, chest pain related to ischemia, and cardiac dysrhythmias.