Pharm Unit 3

CV pt. 2, anticoagulation, fluid and electrolytes, eye and ear

Cardiogenic shock

Medical emergency where the heart cannot pump enough oxygen rich blood

What is considered a high BP?

>140 SBP or >90 DBP

Peripheral vascular resistance

The force against blood flow in the circulatory arterioles

Affected by BV size

How does age affect BP?

Elasticity decreases with age

HTN common in older adults because the BV can’t compensate

What is the trigger for the RAAS?

Low blood flow to the kidneys

• Kidneys release renin that turns angiotensinogen into angiotensin I

• Starts the cascade to increase aldosterone and vasoconstriction

How is the RAAS related to HTN?

It is inappropriately triggering

Calcium Channel Blockers

Verapamil

Nifedipine

Diltiazem

Amlodipine

Calcium channel blockers MOA

Vasodilation of smooth muscle + arteries

↓ contractility

↓ HR

↓ O2 demand

Calcium channel blockers contraindications

Pregnancy

Cardiogenic shock

Acute MI/unstable angina

2nd/3rd degree heart block

Calcium channel blockers adverse effects

Reflex tachycardia

Toxicity

Orthostatic hypotension

Peripheral edema

Calcium channel blockers implications

Notify provider if:

• HR <50

• SBP <90

Don’t chew/crush

Educate to change position slowly

Calcium channel blocker + beta blockers

↓ Risk of reflex tachy

↑ Increase risk of hypotension

Calcium channel blockers interactions

Famotidine + grapefruit = toxicity!!

What is the only calcium channel blocker can be used in pregnancy?

Nifidipine if benefits outweigh the risks

Verapamil (CCB) contraindications

Severe heart failure/blocks

Older adults

Kidney/liver dysfunction

GERD

Verapamil interactions

Digoxin!

Verapamil implications

Very slow IV push

Verapamil + Diltiazem adverse effects

Constipation

Cardiac function suppression

Dysrhythmias