 What comes in nursing school explained in this video on calcium channel blockers, these are medications that we very commonly encounter in the clinical setting and as always we should remember the medication by its class and by their ending of the generic name and calcium channel blockers typically end in either PIN, ZEM or MIL and as we'll later see we'll go over some examples. So for the mechanism of action remember that calcium is needed for muscle contraction and that also pertains to skeletal muscle but in this case we worry or we focus more on the cardiac muscle as well as the vascular smooth muscle with the influx and output of the calcium ions. So calcium channel blockers block these calcium channels and therefore inhibit the calcium movement into the cardiac cells and the vascular smooth muscle cells and calcium channel blockers there are two different types which are the non dihydropyridines and the dihydropyridines. The funny thing about this here is that the non dihydropyridines are cardio selective where the dihydropyridines are non selective so the non and the non here don't match but just remember that they don't match and then you'll be fine from there I think. And so cardio selective means that the cardio selective calcium channel blockers only block the calcium channels in the heart and when they do that they decrease the heart rate, they decrease the conduction through the AV node and therefore the blood pressure gets lowered. And there are really only two medications that I know of that are in these non dihydroxy pyridine class which is diltiazim also known as cardizim and then verapamil. These two are the only ones and they might be used for certain circumstances but then we also have the dihydropyridines which are the ones that are non selective so that means that they now are able to block the calcium channels of the cardiac as well as the vascular smooth muscle cells. So when we talk about smooth muscle relaxation we always talk about vasodilation and that decreases systemic vascular resistance and then the blood pressure will get lower. But they also cause coronary artery dilation because again that's a cardiac smooth muscle and increased perfusion there and these medications in the non selective calcium channel blockers and in PIN so that would be probably the most commonly used ones amlodipine as well as nicaripine. And so calcium channel blockers are used in the treatment of hypertension. They are actually the first line of treatment in the African American population. It's just that research has shown that specifically in this population other medications don't work as well and typically calcium channel blockers are the first line of treatment in this particular population when the patient first starts a medication regimen. But they're also indicated in the treatment of ischemic heart disease angina and specifically also Prince metal and angina which is kind of like the variant angina and that is because they cause this coronary artery dilation and we know that angina is caused by the narrowed coronary arteries or spasm which is that Prince metal angina. And then also calcium channel blockers are used in the treatment of supra ventricular dysrhythmias such as supra ventricular tachycardia SVT and atrial fibrillation AFib. And that is because it slows the conduction of the AV node which is right at the junction between the atria and the ventricles. So now supra ventricular means above the ventricles and that's where these dysrhythmias are from so channel calcium channel blockers work because they just slow down the conduction in that AV node and therefore are very helpful in the treatment of these dysrhythmias. Common side effects are headache, peripheral edema, bradycardia as well as ginger or hyperplasia. And there are really only two medications that I can think of right now that cause ginger or hyperplasia and this is dilantin and anti seizure medication as well as calcium channel blockers and then in terms of side effects just think about it. If they cause a lot of vasodilation like we talked here from the smooth muscle then that fluid has to go somewhere and as the arteries dilate the fluid kind of seeps out and they cause this peripheral edema and then bradycardia clearly because we're slowing the conduction through the AV node but if we slow it down too much then we're going to have bradycardia. In terms of contraindications when not to use calcium channel blockers that is in patients with heart failure that have systolic dysfunction and or an ejection fraction of less than 45% or if there is an AV node dysfunction because then we don't want to slow it down any further most likely patients with AV node dysfunction already have a low heart rate and we don't want to slow it down too much. And then nursing care as always with anything that affects the heart rate as well as blood pressure we want to check those parameters check an EKG to see the rhythm the patient is on to make sure there's nothing going on with the AV node monitor them for signs and symptoms of heart failure by looking at their eyes and nose daily weights as well as educating the patient about the possibility of orthostatic hypotension and the measures that are associated with that also educate the patient on photosensitivity so use sunscreen when going outside and to avoid grapefruit juice because that might actually make them more more might increase their serium levels of their calcium channel blockers. So thanks for watching this video keep in mind calcium channel blockers and in PIN, ZEM or MIL but RAPA MIL or TIAZEM are the cardio selective ones versus the PIN ones are the non-selective ones and they cause a peripheral edema because of that vascular smooth muscle dilation. Please also check out the other videos in my pharmacology playlist particularly that pertain to hypertension because that's a very important chapter and you'll see many patients on a variety of these medications and it's very important to know the differences and nursing considerations of those medications. Please give me a thumbs up also check out my Instagram page for quizzes, study tips and other helpful things that you might find there and I'll see you soon right here on Nursing School Explained. Thanks for watching.