Calcium Channel Blockers and Hypertension (Pharmacology for Nurses)
Calcium Channel Blockers and Hypertension (Pharmacology for Nurses)
This video is about Calcium Channel Blockers, Hypertension and Pharmacology for Nurses
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Timestamps
00:00 Milk and Calcium
01:12 Calcium Channel Blockers Introduction
02:12 Outline for video
03:04 Role of Calcium in the Body
03:24 Role of Calcium in Blood Pressure
03:42 Chronotropic Affect
03:59 Inotropic Affect
04:18 Systemic Vascular Resistance
05:20 Who is prescribed a Calcium Channel Blocker
06:42 Types of Calcium Channel Blockers: Dihydropyridines and Nondihydropidines
09:00 Nondihydropyridines: Verapamil and Diltiazem
10:25 Compare and Contrast dihydropyridines and non dihydropyridines
12:32 Considerations for the administration of calcium channel blockers and follow up
15:11 Side Effects and patient teaching for Calcium Channel Blockers
16:50 NCLEX review
18:36 Wrap up! Whew!
Calcium channel blockers are medications used to treat high blood pressure aka hypertension. Nurses, nursing students, and healthcare providers need to understand how these medications work in order to monitor and teach patients about their impact and side effects.
There are some important questions our patients will ask us and we need to know where to find the right information.
Can I take my CCB with grapefruit juice?
Is it okay if I take it and then measure my blood pressure?
What about other medications, is it safe to use?
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Content
0 -> We are talking about calcium today, you
know you know it. It's in your milk and
5.43 -> we drink it so that we have really hard
strong bones but it's also the stuff
12.3 -> that builds up on our dishes and in our
tubs. Calcium, that stuff we want to get
17.55 -> rid of so how the heck does it connect
to high blood pressure? Well it turns out
24.35 -> just as it makes our bones really hard
and solid, calcium also makes our
30.869 -> muscles contract and makes them firm
which is something we don't want when we
37.649 -> have high blood pressure. We're going to
talk about calcium channel blockers in
41.489 -> this video right after this. Welcome back
my name is Tammy and this is NurseMinder
53.219 -> and on this channel we do
everything nursing so if you're new here
57.059 -> consider subscribing below so that you
get the next video and its released.
60.809 -> Calcium channel blockers are another
classification of medications that we
66.24 -> use to treat high blood pressure also
known as hypertension. We know that high
72.75 -> blood pressure is a silent killer that
means we don't have signs and symptoms
78.869 -> when our blood pressure is elevating
above normal. In the previous video, I'll
84.24 -> put it here,
we did talk about what is high blood
87.72 -> pressure what will the normal values be
and when should you be concerned about
91.32 -> those numbers. Remember you don't have
signs or symptoms and so you won't
96.42 -> feel like there's a problem but there
are definite risks associated with high
101.909 -> blood pressure. In another video we
talked about the stepped management that
107.28 -> we have in dealing with high blood
pressure. the first step is always
110.61 -> looking at those things we can control
such as our diet or environmental
115.29 -> factors whether that's smoking, alcohol,
drug use, exercise. Those pieces that we
121.17 -> can chip away at slowly to make a
difference but when they're ineffective
124.969 -> we need to add medications.
So in this video we're going to talk
128.61 -> about what calcium does. First of all we
need to understand what calcium's role
132.209 -> is so we understand why blocking it is
so effective, then we're talking about
136.14 -> what a calcium channel blocker is so
we're going to uncover the elements that
141.06 -> nurses need to know so how do I identify
a calcium channel blocker? There are some
145.89 -> clues in our drug naming. Who would be
prescribed a calcium channel blocker?
151.519 -> What are the considerations I need to
have before I give this calcium channel
155.97 -> blocker? What are some of the side
effects and patient teaching? And then
160.86 -> some of my follow-up considerations and
things like that so we're going to go
164.4 -> over all those pieces in this video but
let's start with oh and of course stick
169.56 -> to the end because we're going to have
an NCLEX review and in these videos I
173.489 -> give you a question give me some time to
think about it and then we go through
176.34 -> the rationale as to why the question
has a correct answer and incorrect
180.63 -> answer so be sure to stay to the end for
that. What is the role of calcium in the
186.09 -> body? As we talked right at the beginning
it's about making our bones strong, we
191.85 -> need them for muscle contraction, that's
right baby,
195.69 -> we also need them for our teeth and
there's a lot of things that our body
201.09 -> needs calcium for. When it comes
to where calcium works inside our
205.53 -> cardiovascular system and how that
impacts our blood pressure we need to
209.34 -> look at three key things: the first is
rate,
212.37 -> the second is force and the third is
resistance. So calcium is needed to
217.98 -> control the rate of the heart. The SA
node and the AV node these generate
223.35 -> their own electrical impulses I talked
about this in our ECG training I can put
228.03 -> the description below if you're
interested in more, but calcium really is
231.66 -> like the igniter the one that causes
that muscular contraction. That muscular
236.609 -> contract is responsible for the force,
when the heart contracts, how hard does
241.799 -> it need to work in order to expel the
blood out of the ventricles to the
247.049 -> body, Now when it is
contracting to move that forward out of
252.78 -> the ventricles to the body there is a
third factor and that's resistance. You
257.459 -> can imagine that if we have a small tube
we have to push really hard to get our
263.4 -> fluid through it or as if we have a
really wide tube it's really little
268.05 -> effort. It's almost like walking through
a door. If you consider this first tube
272.55 -> this really small narrow vessel to be
like a doorway that's barely open and
277.08 -> you're trying to wiggle your way through
it you have to exert a lot of pressure
280.86 -> to get through but if the door is wide
open
283.979 -> and you can just walk through easily it
doesn't require you to put forward a lot
288.57 -> of effort to get through the door. The
same is true here the same is true here
293.219 -> so calcium is required for the rate, we
need it for the SA node to function
298.56 -> inside your heart, we also need it to
create a contraction inside the muscles
303.539 -> of the heart, and thirdly these would be
the peripheral vessels so as the blood
308.46 -> leaves the heart how narrow - how wide
those vessels are to deliver the
313.979 -> arteries in particular, to deliver the
blood to the body is is a factor of
319.14 -> calcium.
322.19 -> Now let's look at those who would be
326.279 -> prescribed a calcium channel blocker.
Obviously because we're talking about
330.3 -> high blood pressure in this video yes it
is a treatment for high blood pressure.
336.259 -> It is also used for angina and
for vasospasm so this would be like
341.55 -> exercise induced chest pain where those
vessels are maybe slightly occluded and
346.77 -> not quite getting enough oxygen we have
a little bit of discomfort relieved with
351.209 -> the medication because it causes
dilation and you may also have a patient
357.33 -> on a calcium channel blocker who has a
cardiac arrhythmia such as atrial
361.8 -> fibrillation because it will slow the
conduction down between the SA node to
365.669 -> AP node and help to regulate that
contraction. Now another group of
371.939 -> patients who may have a calcium channel
blocker are those who have a diagnosis
376.08 -> of heart failure but there are some
special precautions that we need to know
380.789 -> about because people in heart failure
are dependent upon preload. So we look at
386.669 -> the different categories now of calcium
channel blockers and really dive into
390.449 -> they have specific sites that they're
more likely to have an impact on such as
395.009 -> rate, force, and resistance. So let's get
started with looking at the categories.
404.389 -> Now there are two groups of calcium
channel blockers and then within one of
410.12 -> those we have two subgroups this is
usually where students tune out
414.189 -> Snoozeville
Just stick with me for this little
418.879 -> complicated piece because you're generally not gonna see this on NCLEX
422.03 -> but it helps to just put things into
their categories right, they should be
425.33 -> put into the blocks that they belong.
Dihydropyridine's is the first group
431.21 -> and then the other group is non
dihydropyridines. Okay so we've got the
436.4 -> dihydropyridine and those are commonly
the ones that end in PINE, in
442.819 -> fact many of them actually have DIPINE
on the end di P I NE. You'll see
448.43 -> that a lot so amlodipine, nifedipine, felodipine, those are examples of
455.84 -> the dihydropyridine they are primarily
focused on vascular vasodilation so
464.33 -> they're really looking at creating more
space within the vessels for the blood
468.74 -> to pool, not to pool, for the blood to
reside which means it's gonna take
472.909 -> longer to get to the heart we're gonna
have a little bit less fluid entering
476.569 -> into the chamber so my preload, the
amount of fluid coming in to the heart
480.169 -> is less, the amount going into the
ventricles is less and then when it's
484.159 -> pushing out of the heart you know just
like this if you were to walk through a
487.879 -> door for example it when the doors wide
open it's really easy to walk through
492.77 -> the door and that's what's happening
with dihydropyridines is that they are
497.139 -> widening the gap in which the blood is
going to go through. So the pressure in
502.339 -> the after load, the resistance is
decreased. This overall makes it easier
507.319 -> for the heart to do its job as you can
imagine walking through a wide open door.
511.599 -> When the vessels are vasoconstricted
or that door just has that little tiny
515.99 -> opening and you try to squeeze yourself
through it all that extra effort you
520.19 -> have to put into getting through that
door that's just barely opened is the
524 -> same as the heart trying to push blood
through a vessel that's really small.
527.899 -> It's resisting. It's pushing back and so
the heart has to push harder so
533.149 -> dihydropyridine are focusing on
decreasing the pressure
537.75 -> that is needed to push forward that
blood.
542.19 -> The second grouping is the non
dihydropyridineS and within there there's
547.17 -> two different classifications. Really
what this is just talking about when we are
551.43 -> breaking it all down into its chemical
structure is that they are chemically
555.18 -> different but they have similarities in
how they work to decrease blood pressure
558.96 -> and so they become classified as calcium
channel blockers but they don't all look
563.4 -> the same
chemically that's why they have
565.56 -> different groups. Within the non
dihydropyridineS is where we're going to
571.11 -> find
verapamil it's a phenylalkaline
573.66 -> which is an example of a non
dihydropyridine, Don't don't tap out here!
581.34 -> I know it's a lot of words that we don't
have a context around. They're not as
586.53 -> important as what happens clinically
when we are on a calcium channel blocker
590.28 -> and in particular these three different
classifications or these three
593.55 -> different types have some particular
things we need to watch out for. The
597.78 -> other group of nondIhydropyridines
are the benzodiazepines
605.52 -> and the example that is diltizem. So now that we've got just that
611.03 -> scientific piece taken care of let's
compare the dihydropyridines
617.16 -> to the non dihydropyridine in terms of
how they affect the vessels and the
623.28 -> heart rate.
626.52 -> All right. So now it's time to look at
where these specific drugs have an
630.22 -> affinity towards. So they're really drawn
to really work in a particular area
636.03 -> now amlodipine (to use P I N E S for some
clues) we can look at this as the P
643.69 -> prevents pressure in the extremities and
so we're looking at that peripheral
649.9 -> resistance and so is it gonna affect
rate? No. Is it gonna affect how
655.75 -> strong my muscles contract? No, It's going
to prevent pressure in the
663.37 -> extremities that's my clue in the pine; P
is for prevent pressure in extremities
668.95 -> So it's going to be working on vessel
size so this is the affinity of all
674.08 -> those drugs that end in PINES, amlodipine, nifedipine are looking to reduce
679.18 -> the pressure in those vessels which
means we're going to vasodilate. Now
684.91 -> when it comes to our non dihydropyridine
so that's our verapamil and diltiazem,
690.46 -> these are more likely to effect a change
in heart rate and muscle contraction. So
698.59 -> heart rate and muscle contraction and
one of the ways you can remember this is
704.11 -> that both of these have the letter M in it, M for muscle M for mighty and so we're
711.07 -> going to be changing the rate down are
going to slow it down and we're going to
715.36 -> relax the muscles to decrease our blood
pressure. Now remember when someone's in
723.49 -> heart failure they are dependent upon
the fluid coming back to the heart.
727.83 -> They've already got a weak heart it's
not functioning properly and it's
732.49 -> already decreasing the amount of blood
it can pump out so we would not want to
737.23 -> see a patient on a dihydropyridine such
as amlodipine because remember PINES
745.29 -> will prevent the pressure in the
extremities
748.7 -> and they're going to drop even further
and having even less blood coming back to
753.53 -> the heart and that could be disastrous.
759.07 -> Okay so now we're ready to give this
medication. These medications for the
764.57 -> most part our oral tablets or capsules.
Now here's a critical thing if you have
770.54 -> a long-acting or an extended-release I
should say an extended-release tablet do
775.79 -> not cut it in half without talking with
your pharmacy first. When we have a
782.98 -> sustained-release
pill as soon as we cut it in half we've
787.28 -> actually broken the integrity of the
pill and now we'll get a quicker release
794 -> and we can have toxic buildup of
medication. So be careful which pills you
798.65 -> are separating into two. Of course before
we give them we need to do an assessment
803.66 -> we're going to assess our patient's
cardiovascular system which includes
806.96 -> vital signs we want to do an ECG to find
out what their baseline is you'll want
812.15 -> to listen to the lungs because if these
medications are slowing the heart rate
817.19 -> and increasing the amount of blood that
the vessels can hold there is a risk for
822.92 -> some edema in the lungs so we definitely
want to be listening to the lungs as
826.67 -> well and of course your lab work should
include liver and kidney profiles
832.13 -> because the drug is metabolized by the
liver and excreted in the kidneys. If
837.53 -> your patient has a history of liver or
kidney disease that would be a
840.71 -> consideration in dosing as well. One of
the biggest things you need to remember
845.27 -> before you give this medication is that
you need to check for heart rate and
849.44 -> blood pressure. This is usually tested in
your NCLEX as well there's another NCLEX
854.09 -> tip for you it's on your patients
findings so you definitely want to be
857.18 -> watching for a systolic blood pressure
of greater than 90 and a heart rate of
861.29 -> greater than 60 before you consider
giving this medication. If it's lower than
866.36 -> either of those values you'll want to
hold it and reassess with the doctor.
869.51 -> Part of the patient teaching is that
because this is given calcium channel
874.34 -> blockers are given to decrease blood
pressure is
876.98 -> that they may need to change position
slowly if they start to notice they're a
881.72 -> little bit faint or woozy when they get
up really quickly. Here's a really
885.35 -> important consideration that your
patients need to know. If they're taking
889.43 -> a calcium channel blocker they should
not be taking grapefruit juice at the
892.73 -> same time. In fact they should be spacing
it out by like four hours so it may just
898.25 -> be even better just to avoid it all
together - and the reason grapefruit
901.88 -> juice is a no-no is because when
grapefruit juice is present in the
905.06 -> system the concentration of calcium
channel blockers increases.
913.049 -> So now that we know how the drugs work,
predicting what side effects we could
918.429 -> expect or anticipate becomes easier. Now
that I know that my dihydropyridine are
924.489 -> focused primarily on peripheral vascular
resistance opening up those vessels I
930.309 -> might think that we've got swelling and
edema happening now I have less blood
935.769 -> flow coming to the heart I might have
some problems with the patient feeling a
940.569 -> little bit uncomfortable dizzy, faint
because they're not having as much
945.309 -> perfusion and that impacts the amount of
output from the left side of your heart.
950.999 -> With anything we take into our mouth we
always have nausea to consider. We can
957.16 -> end up with a reflexive tachycardia
meaning that the heart has not been
961.569 -> giving as much fluid as it normally
likes we've decreased that and then the
965.319 -> heart's that whole
renin-angiotensin-aldosterone
969.249 -> pathway the baroreceptors are all
triggering for the heart to work harder
973.72 -> and so you may end up having a
tachycardia so you'll want to watch for
977.799 -> that as well. Now in addition for those
patients who are on the non
981.609 -> dihydropyridine we know that they have
an affinity towards the SA node and the
986.799 -> muscle contraction itself. So in
particular they often are used to treat
991.839 -> arrhythmias however they can also cause
arrhythmia so we definitely want to be
996.189 -> following up on our patients EKGs to
make sure we're not getting into a heart
1000.179 -> block of some sort as a result of that
calcium being prevented from entering
1004.799 -> into those cells. So now it's time for an
NCLEX review :)
1013.47 -> The nurse is discharging a patient home
on a new sustained-release calcium
1018.73 -> channel blocker what is a priority
teaching point about this medication? a)
1024.66 -> be sure to take your blood pressure two
hours after you have taken your
1028.299 -> medication B) swallow the pill whole and
do not crush cut or chew it C) take the
1036.04 -> drug with grapefruit juice to prevent
stomach upset D) headaches can be a side
1041.29 -> effect of this medication. Go ahead and
make your selection. All right now let's
1047.079 -> take a look at these answers. If you
selected a take your blood pressure two
1050.559 -> hours after your medication that be
incorrect and the reason is we need to
1054.91 -> assess blood pressure and heart rates
before giving these medications. If you
1058.87 -> said B swallow the pill hole do not cut
crush or chew it that would be the
1063.07 -> correct answer because we know this is a
sustained release drug and when we cut
1067.69 -> it we have changed the integrity of the
pill and they are at risk of drug
1071.679 -> toxicity. If you selected C take the drug
with grapefruit juice to help prevent
1077.02 -> stomach upset
well we actually want to avoid
1079.57 -> grapefruit juice because grapefruit juice
will increase the concentration of
1083.71 -> calcium channel blockers not what we
want. And if you selected D headaches are
1089.08 -> or headaches can be a side effect of
this medication you would be correct. Yes
1093.25 -> it is a side effect of these medications
but is that the priority? The priority
1098.23 -> is airway, breathing, circulation, pain.
ABC's pain and so in this case if we
1104.01 -> crush the pill cut it in half we have
toxicity and then we're at risk of an
1112.27 -> airway, breathing, circulation, problem.
Thanks for watching I hope you learned a
1117.01 -> ton because it was an awful lot of fun
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1124.54 -> that like button and write me a comment
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1127.809 -> if you have some ideas I'd like to hear
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1132.909 -> great day :)
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1135.49 -> get off your phone or go back to work
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1138.82 -> off to go to sleep so why don't you
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1141.909 -> watching another video THANKS!
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