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Calcium-channel blockers: Nursing pharmacology

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Notes

Notes

CALCIUM-CHANNEL BLOCKERS
DRUG NAME
Dihydropyridines: nifedipine (Procardia, Adalat), amlodipine (Norvasc), clevidipine (Cleviprex), nicardipine (Cardene), felodipine (Plendil), nimodipine (Nimotop)

Non-dihydropyridines: diltiazem (Cardizem), verapamil (Calan, Isoptin)
CLASS
Calcium Channel Blockers (CCB)
MECHANISM OF ACTION
  • Block the entry of calcium into the cells
  • Reduce the contraction of vascular smooth muscle and cardiac muscle
    • Dilate arterioles, and reduce blood pressure and peripheral vascular resistance
    • Dilate coronary vessels and increase oxygen supply to the heart
    • Reduce force of contraction of cardiac muscles and reduce oxygen demand of the heart
  • Reduce the firing and conduction of impulse through the SA and AV nodes in the heart
INDICATIONS
  • Cardiac arrhythmia, hypertension, angina pectoris, tocolysis in preterm labor, Raynaud’s phenomenon, migraine prophylaxis
  • Nimodipine: subarachnoid hemorrhage
ROUTE(S) OF ADMINISTRATION
  • PO
  • IV
SIDE EFFECTS
  • General: headache, dizziness, flushing of the skin, peripheral edema, hypotension
  • Dihydropyridines: reflex tachycardia, gingival hyperplasia
  • Non-dihydropyridines: bradycardia, constipation and hyperprolactinemia
CONTRAINDICATIONS AND CAUTIONS
  • Pre-existing bradycardia
  • Heart block
  • Heart failure
  • Use with caution: hepatic and renal disease
  • Interactions: digoxin, grapefruit
NURSING CONSIDERATIONS: CALCIUM-CHANNEL BLOCKERS
ASSESSMENT AND MONITORING
  • Vital signs, CBC, sodium, potassium, creatinine, BUN, liver function tests, and urinalysis, ECG
  • For angina: frequency and severity of symptoms
  • Monitor for side effects and therapeutic response
CLIENT EDUCATION
  • Purpose of medication
  • Self-administration
    • Take exactly as prescribed, do not stop abruptly
    • Swallow whole; do not divide, crush, or chew
    • Avoid grapefruit juice and limit caffeine
  • Side effects
    • Hypotension and reflex tachycardia: change positions slowly
    • Peripheral edema: elevate legs
    • Constipation: increase fiber and fluids
    • Gingival hyperplasia: good dental hygiene
  • Lifestyle modifications for cardiovascular health
  • Heart rate and blood pressure self-monitoring
  • Report persistent side effects, hypotension, bradycardia; seek medical attention if angina not relieved by rest or medication

Sources

  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology - A Patient-Centered Nursing Process Approach (8e)" Elsevier Health Sciences (2014)
  3. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2020)
  4. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2018)
  5. "First Aid for the USMLE Step 1 2018, 28th Edition" McGraw-Hill Education / Medical (2018)
  6. "Rang and Dale's Pharmacology" Elsevier (2018)
  7. "Basic & Clinical Pharmacology (15e)" McGraw Hill (2021)
  8. "Calcium Channel Blockers" StatPearls [Internet] (2021)
  9. "Calcium Channel Blocker" Wikipedia (undefined)
  10. "Mosby's 2021 Nursing Drug Reference" Mosby (2021)

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