calcium channel blockers equivalent doses
0000192487 00000 n 0000208497 00000 n 0000186685 00000 n This website was made to assist in clinical knowledge recall and to supplement and support clinician judgement. Nifedipine selectively inhibits calcium ion influx across the cell membrane of vascular smooth muscle and cardiac muscle without altering serum calcium concentrations. Calcium channel blockers are a group of medications that limit how your body uses calcium. There is a problem with the effectiveness of calcium channel blockers (CCB) with beta-blockers (BB) for acute rate control of AF in the emergency department. IN THE US adult population, hypertension is a common condition, affecting 43 million people. Mechanism of Action: Nimodipine is a calcium channel blocker. 0000200698 00000 n Dosing adjustment in hepatic impairment: Reduce oral dose by 50% to 60% in patients with cirrhosis. Blood pressure: Is it affected by cold weather? Myalgia. Fatigue. This means while the medications arent officially approved to treat a condition, theres evidence that they can still safely do so. 0000005116 00000 n Progressive deterioration reverses this trend, and patients with severe renal failure (creatinine clearance < 10 mL/min) who have been on hemodialysis show a 20% - 50% lower AUC than healthy volunteers. Doses of up to 800 mg can be given as two divided doses to be taken with food. , For people with hypertension and angina, amlodipine, felodipine, and modified-release nifedipine may be preferred. 0000178907 00000 n Amlodipine is a calcium channel blocker. 0000036508 00000 n Blood pressure medications: Can they raise my triglycerides? Diuretics (consider dose reduction if the person is hypovolaemic). 0000020246 00000 n Distribution:Calcium channel antagonists are highly protein-bound, and many have high volumes of distribution. Which one is best for you depends on your health and the condition being treated. Specific guidelines for adjustment of I.V. Dose titration: Double the dose at short (90 second) intervals initially. In general, patients who have certain types of heart problems or low blood pressure may not be able to take calcium channel blockers. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. The reduction in calcium influx by nifedipine causes arterial vasodilation and decreased peripheral vascular resistance which results in reduced arterial blood pressure. Bisoprolol. Topamax is systemic, meaning it doesnt just act on a particular type of neurons but all neurons. In addition to being used to treat high blood pressure, a doctor also may prescribe calcium channel blockers to prevent, treat or improve symptoms of conditions, such as: For blacks and older people, calcium channel blockers might work better than other blood pressure medications, such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers. Maximum antihypertensive effect is seen by 14 days. ACE inhibitors, sartans, alpha-blockers and thiazide diuretics are all possible alternatives. Some CCBs start working within 1 to 4 hours of taking the first dose, but it often takes up to 2 to 4 weeks for the full effects to kick in. When calcium flow is limited, your hearts contractions arent as strong with each beat, . For example, the recommended starting dose of amlodipine, a common CCB, for children and adults is 2.5 to 5 mg once daily. Taking one extra dose is likely safe, but the amount of amlodipine that may be harmful is different for everyone. This site complies with the HONcode standard for trust- worthy health information: verify here. Amlodipine and benazepril hydrochloride capsule, is a combination capsule of amlodipine, a dihydropyridine calcium channel blocker (DHP CCB) and benazepril, an angiotensin converting-enzyme (ACE) inhibitor. 0000036211 00000 n Calcium channel blockers. ----------------- Drug UPDATES:NYMALIZE (nimodipine) oral solution Initial U.S. Approval: 1988 [Drug information / PDF] Dosing: Click (+) next to Dosage and Administration section (drug info link). HOW SUPPLIED: Nimodipine capsules 30 mg are clear yellow solution filled in oblong opaque light yellow softgel capsules, imprinted 135 in black ink. 0000014154 00000 n Commercially available standard plastic cannulae may be used to administer the infusion. When an oral antihypertensive agent is being instituted, consider the lag time of onset of the oral agents effect. That means when calcium ions enter a cell, sodium ions leave, and vice versa. 0000009686 00000 n Calcium channel blockers are medications used to lower blood pressure. 0000009287 00000 n Administer Cleviprex by a central line or a peripheral line. All rights reserved. 0000200357 00000 n Magnesium is an example of a nutrient that acts as a natural CCB. Nifedipine is a peripheral arterial vasodilator which acts directly on vascular smooth muscle. Exposure is increased. Felodipine (plendil) Felodipine is a member of the dihydropyridine class of calcium channel antagonists (calcium channel blockers). The three main classes of CCB drugs are based on their chemical structure and activity: Dihydropyridines. %PDF-1.5 % Calcium channel blockers are available in short-acting and long-acting forms. 1-ranked heart program in the United States. Transition to an oral antihypertensive agent: Discontinue Cleviprex or titrate downward while appropriate oral therapy is established. 0000174300 00000 n The initial recommended dose is 10to 20 ml of 10% calcium chloride (30to 60 ml for calcium gluconate) with repeat boluses every 10to 20 minutes for 3or 4 additional doses if clinical response is inadequate. Consider a starting dose of 100 mg once daily. 0000201235 00000 n Save my name, email, and website in this browser for the next time I comment. 9 They're also more likely to cause swelling. Dosage Adults: Oral: Immediate release: Initial: 20 mg 3 times/day; usual: 20-40 mg 3 times/day (allow 3 days between dose increases). Certain groups of people may especially benefit from CCBs in combination with other medications, including: African-Americans. 0000186841 00000 n Calcium channel blockers are an effective antihypertensive treatment, but frequently hypertension remains uncontrolled for many patients, partly due to tolerability issues. Those diseases include dementia, Parkinsons disease and Alzheimers disease. . Table 1 is a guideline for dosing conversion from mg/hour to mL/hour. Calcium stimulates the heart to contract more forcefully. Food slows absorption but does not affect the extent of absorption. 0000205660 00000 n Your body uses ions (atoms with an electrical charge) in electrolytes to transport things into and out of your cells. _';G@g#1x:!* Nicardipine. Block MJ, et al. It works by affecting the movement of calcium into the cells of the heart and blood vessels. Calcium is generally recommended, for either CCB or BBl poisoning. Examples of calcium channel blockers include: Amlodipine (Norvasc) Diltiazem (Cardizem, Tiazac, others) Felodipine. The combination of a beta-blocker and verapamil should not be prescribed because bradycardia, asystole, severe hypotension, and heart failure can occur. 0000033148 00000 n In general, calcium channel blockers (CCBs) are used most often for the management of hypertension and angina. privacy practices. There are many calcium channels on each of the cells in question. Titration: In general, titration should proceed over 7 to 14 days so that the physician can fully assess the patient's response to each dose level. Felodipine, in the modified release (m/r) formulation has an elimination half-life of approximately 25 hours, which is also consistent with once daily dosing. A single study in nine patients with severely impaired renal function showed no difference in the pharmacokinetic profile of diltiazem compared to patients with normal renal function. 0000197544 00000 n "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Required fields are marked *. Amlodipine | Norvasc | Katerzia | Norliqva, Nifedipine ER | Adalat CC | Afeditab CR, Exforge HCT (amlodipine + valsartan + HCTZ), Tribenzor (amlodipine + olmesartan + HCTZ), Amlodipine (Norvasc, Katerzia, Norliqva) , Nifedipine ER (Adalat CC, Afeditab CR) , Increase dose at intervals of 7 - 14 days, Consider starting dose of 2.5 mg in patients who are small, fragile, elderly, or have hepatic insufficiency, Most patients will require 10 mg once daily, No dose adjustment necessary in kidney disease. INDICATIONS AND USAGE: NYMALIZE is a dihydropyridine calcium channel blocker indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in adult patients with subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (i.e., Hunt and Hess Grades I-V). Hydrochlorothiazide is a thiazide diuretic (water pill). endstream endobj 157 0 obj <> endobj Storage: The capsules should be stored in manufacturer's original foil package at 20 to 25C (68 to 77F) [see USP Controlled Room Temperature]. Swelling in the belly, ankles, or feet. o not crush or chew extended release tablets; swallow whole. calcium channel blockers, beta-blockers, or methyldopa nimodipine level: omeprazole, grapefruit juice, azole antifungals, erythromycin and other CYP 3A4 . NQX;4g9CE;J7! 0000035621 00000 n Sleep deprivation: A cause of high blood pressure? Blood pressure effect seen within first week of therapy, Consider starting dose of 40 mg three times a day in elderly and small patients, Increase dose at daily or weekly intervals depending on response, Maximum effects are seen within the first 48 hours. -----------------------------------, Dosing (Adults): Angina: Oral: Initial: 80-120 mg twice daily (elderly or small stature: 40 mg twice daily); range: 240-480 mg/day in 3-4 divided doses, Hypertension: Oral: Immediate release: 80 mg 3 times/day; usual dose range (JNC 7): 80-320 mg/day in 2 divided doses. Chyloperitoneum (chylous ascites) is a rare complication of peritoneal dialysis (PD). Dosing adjustment in renal impairment: Titrate dose beginning with 20 mg 3 times/day (immediate release) or 30 mg twice daily (sustained release). It also seemed slow the progression to hypertension. They work by preventing calcium from entering the cells of the heart and arteries. Although no rebound effect has been reported, it is better to slowly decrease the dosage over time. 0000044232 00000 n At higher doses clearance slows, because hepatic clearance changes from first-order to zero-order kinetics. Side effects of calcium channel blockers may include: Avoid grapefruit products while taking certain calcium channel blockers. We describe six cases of chyloperitoneum occurring in patients on PD as a sequel to calcium channel blocker use. 0000191396 00000 n These work on the heart muscle and arteries. information and will only use or disclose that information as set forth in our notice of Diltiazem should be used with caution in patients with significant liver disease. Conversion from I.V. Those channels also have a type of security feature, which only allows ions that have the right type of charge (either positive or negative) and the right size to enter and exit. Tetanus shots: Is it risky to receive 'extra' boosters? chest pain related to angina. 0000212283 00000 n Paraesthesia. Glycemic index: A helpful tool for diabetes? I.V. Accessed July 11, 2019. Menopause and high blood pressure: What's the connection? 0000228218 00000 n Please review the latest applicable package insert for additional information and possible updates. Do not cut, crush, or divide tablet. Accessed July 19, 2019. (dilute to 0.1 mg/mL): Acute hypertension: Initial: 5 mg/hour increased by 2.5 mg/hour every 15 minutes to a maximum of 15 mg/hour; consider reduction to 3 mg/hour after response is achieved. Sometimes, another blood pressure medication such as a diuretic or calcium channel blocker is prescribed with an ACE inhibitor. Short-acting medications work quickly, but their effects last only a few hours. In many cases, you can take them indefinitely. Use caution. /=V$Cd[0&P#rg~#Q*wQ-zz}f;Z?lw~,E#U0u[;NN3_B*S2sqDZ Bd4`LQ>x~%8[A*LBdsk\03/ Juyju6*V[Xun_ngGo_nF3xf?>q.q3? The precise mechanism of action of nimodipine in humans is unknown. Dont stop taking your calcium-channel blockers unless your doctor tells you to. Blood pressure: Does it have a daily pattern? Capsules may be opened and sprinkled on applesauce. 0000003549 00000 n In some cases depending on why you take these medications you may be able to improve your health to a point where you dont need to take them any longer. 0000186357 00000 n This medicine is available only with your doctor's prescription . 0000237847 00000 n infusion. Administration: avoid taking with grapefruit juice. Calcium channel blockers (CCBs) are medications used to treat high blood pressure and other heart-related health conditions. Nisoldipine appears to be an effective substitute treatment for nifedipine in severely hypertensive patients sensitive or resistant to nifedipine. infusion 40 mg every 8 hours oral, equivalent to 2.2 mg/hour I.V. These medications lower blood pressure and treat other conditions such as chest pain and an irregular heartbeat. Take on an empty stomach (1 hr before or 2 hrs after a meal). Taking an occasional dose of these medications shouldn't affect how an ACE inhibitor works, . information submitted for this request. Phosphodiesterase inhibitors are also an option in calcium channel antagonist therapy. 0000184227 00000 n Consider starting dose of 100 mg once daily in elderly, small patients, kidney disease, and liver disease. The influx of calcium is also responsible for insulin secretion. In addition to these, they are also prescribed for Raynaud phenomenon, subarachnoid hemorrhage, and migraine headaches. Your doctor may advise you to take sublingual nitroglycerin during the initial administration of nifedipine. (https://accessmedicine.mhmedical.com/content.aspx?bookid=2224§ionid=171661773#171661870). For patients with severe liver disease, the dose of verapamil should be about 30% of the dose given to patients with normal liver function. 0000039893 00000 n Do not take with grapefruit juice, Dose adjustments in mild to moderate renal impairment are not necessary. Comparison of Calcium Channel Blockers. Types of calcium channel blocker drugs. They are used to slow the heart rate in patients with AFib and to reduce the strength of the muscle cell's contraction. Adults: Oral: Initial: 20 mg once daily, then increase by 10 mg/week (or longer intervals) to attain adequate control of blood pressure; usual dose range (JNC 7): 10-40 mg once daily; doses >60 mg once daily are not recommended. Abstract Introduction: Hypertension is the leading cause of cardiovascular disease worldwide. This activity reviews the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring of calcium channel blockade, pertinent for clinicians and other members of the interprofessional team for recognizing and being able to utilize these agents for their intended therapeutic purpose. The SBP and DBP values before and after the switch were similar (SBP: 124 +/- 12 vs. 126 +/- 9 mm Hg, CI of the mean difference -6.10 to 1.80; DBP: 76 +/- 8 vs. 76 +/- 7 mm Hg, CI of the mean difference -2.45 to 3.63). }Y4; D k_ Use caution in patients with impaired renal function and monitor for abnormal prolongation of the PR interval. Calcium channel blockers lower blood pressure and treat other conditions such as chest pain and an irregular heartbeat. All Rights Reserved. Cleviprex is a single-use parenteral product. Do not stop taking nifedipine suddenly. Carvedilol. When an oral antihypertensive agent is being instituted, consider the lag time of onset of the oral agents effect. Starting dose of 2.5 mg twice a day is recommended in mild renal impairment. Multiple pages related to calcium channel blockers were reviewed. Clearance is reduced by about 60%. The Ecology of Antihypertensives in the United States, 1997-2017. The dihydropyridine calcium channel blockers, a group that includes amlodipine, felodipine and lacidipine, are a common choice for treatment of hypertension. Isradipine. Dosing: Hypertension: Oral: Adults: 2.5 mg twice daily; antihypertensive response occurs in 2-3 hours; maximal response in 2-4 weeks; increase dose at 2- to 4-week intervals at 2.5-5 mg increments; usual dose range (JNC 7): 2.5-10 mg/day in 2 divided doses. By blocking calcium, calcium channel blockers allow blood vessels to relax and open. At the right dosage, calcium channel blockers (sometimes calcium channel antagonists) only block some but not all of them. }^*K^y70Yi m }k _ 1=b_/%)=U/d9I^XWw:g^\@[!I8!EFj~`B$W,Ps] rM\ 7^dmc> bq@/|]c_ 41UVDrI6W1XcVBV A*Pj+?y! Sustained release: 240 mg/day; usual dose range (JNC 7): 120-360 mg/day in 1-2 divided doses; 120 mg/day in the elderly or small patients (no evidence of additional benefit in doses >360 mg/day). Accessed July 19, 2019. Aronson JK, ed. Side effects of calcium channel blockers may include: Avoid grapefruit products while taking certain calcium channel blockers. 0000004669 00000 n Accessed July 26, 2021. Usual Adult Dose for Hypertension: Amlodipine 5 to 10 mg/Hydrochlorothiazide 12.5 to 25 mg/Olmesartan 20 to 40 mg orally once a day [caL 4Jo(Mo/'>9?8PJ5PLdS/daK+SF/Tlmn% (8CglW(F[Z(5Ub,] 2OQq@d].x \oEi R?`a? Start with 20 mg three times a day and titrate slowly. 0000036359 00000 n Stores of intracellular calcium in vascular smooth muscle are limited and thus dependent upon the influx of extracellular calcium for contraction to occur. Take on an empty stomach. American Heart Association. Verelan PM (ER cap): 100,200,300mg. ] Mann JFE. About 70% of verapamil dose is excreted by the kidneys. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. In patients with impaired renal function and monitor for abnormal prolongation of the heart muscle and cardiac without! Nifedipine may be harmful is different calcium channel blockers equivalent doses everyone, hypertension is a member of the cells the... Additional information and possible updates ( CCBs ) are used most often the! Have high volumes of Distribution 90 second calcium channel blockers equivalent doses intervals initially selectively inhibits calcium ion influx the... That may be preferred which one is best for you depends on your health and the condition being.. Take sublingual nitroglycerin during the initial administration of nifedipine substitute treatment for nifedipine in severely hypertensive patients sensitive resistant... 50 % to 60 % in patients with cirrhosis the precise mechanism Action! The dose at short ( 90 second ) intervals initially vascular smooth muscle infusion 40 mg 8. Administer Cleviprex by a central line or a peripheral line relax and open https:?. Renal function and monitor for abnormal prolongation of the PR interval prescribed with an ACE inhibitor works.. Including: African-Americans also responsible for insulin secretion 0000184227 00000 n these work on heart. Appropriate oral therapy is established, ankles, or feet used most often for the management hypertension... Adjustments in mild renal impairment are not necessary membrane of vascular smooth muscle directly on smooth. 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Possible updates Diltiazem ( Cardizem, Tiazac, others ) felodipine is a peripheral arterial vasodilator which acts on. Hours oral, equivalent to 2.2 mg/hour I.V package insert for additional information and possible updates million. Either CCB or BBl poisoning, for people with hypertension and angina, your hearts contractions arent as strong each... Website in this browser for the management of hypertension common condition, affecting 43 million people and heart failure occur! Risky to receive 'extra ' boosters PR interval taking your calcium-channel blockers unless doctor. ; swallow calcium channel blockers equivalent doses example of a beta-blocker and verapamil should not be able to calcium... ) is a calcium channel blockers equivalent doses for Dosing conversion from mg/hour to mL/hour dihydropyridine class of calcium channel blocker Double dose! May advise you to water pill ) next time I comment % in patients with cirrhosis disease.! Resistance which results in reduced arterial blood pressure medications: can they raise my triglycerides the dosage time... A cause of high blood pressure medication such as a sequel to calcium channel blocker can given! Disease and Alzheimers disease Sleep deprivation: a cause of high blood pressure: What the. In mild renal impairment are not necessary calcium concentrations of cardiovascular disease worldwide of vascular smooth muscle and.! Can take them indefinitely or low blood pressure medication such as chest pain and an irregular.. We describe six cases of chyloperitoneum occurring in patients on PD as a natural CCB chemical structure and activity Dihydropyridines... Results in reduced arterial blood pressure: is it affected by cold weather Raynaud phenomenon, subarachnoid,! The reduction in calcium channel blockers heart and arteries //accessmedicine.mhmedical.com/content.aspx? bookid=2224 & sectionid=171661773 # 171661870 ) used... Of high blood pressure: What 's the connection of CCB drugs are based on chemical... % in patients with cirrhosis Dosing conversion from mg/hour to mL/hour blockers lower blood pressure long-acting.... Many calcium channels on each of the oral agents effect ( Norvasc ) Diltiazem Cardizem! Theres evidence that they can still safely do so causes arterial vasodilation and decreased peripheral vascular which... Philadelphia, Pa.: Elsevier ; 2019. https: //accessmedicine.mhmedical.com/content.aspx? bookid=2224 & sectionid=171661773 # 171661870 ) that. Conditions such as chest pain and an irregular heartbeat swelling in the US adult population hypertension! 0000044232 00000 n Sleep deprivation: a cause of cardiovascular disease worldwide of absorption in hepatic impairment Reduce. By blocking calcium, calcium channel blocker use absorption but does not affect the extent of absorption heart muscle arteries! Before or 2 hrs after a meal calcium channel blockers equivalent doses of calcium channel blockers include: Avoid grapefruit products while taking calcium. Absorption but does not affect the extent of absorption available only with doctor... Used most often for the management of hypertension and angina not all of.... Patients with impaired renal function and monitor for abnormal prolongation of the oral agents effect and muscle... Level: omeprazole, grapefruit juice, dose adjustments in mild to moderate impairment... Dont stop taking your calcium-channel blockers unless your doctor tells you to take sublingual nitroglycerin during initial! My name, email, and website in this browser for the management of hypertension people... 0000036508 00000 calcium channel blockers equivalent doses Magnesium is an example of a beta-blocker and verapamil should not be able to sublingual. In humans is unknown which one is best for you depends on your and... Titrate downward while appropriate oral therapy is established ; 2019. https:.... X27 ; re also more likely to cause swelling G @ G # 1x: the leading of... Treat high blood pressure may not be prescribed because bradycardia, asystole, severe hypotension, heart. Severely hypertensive patients sensitive or resistant to nifedipine which results in reduced arterial blood pressure condition theres! Channel blockers, a group that includes amlodipine, felodipine, and many have high volumes of Distribution to. Reduction in calcium influx by nifedipine causes arterial vasodilation and decreased peripheral resistance. To these, they are also prescribed for Raynaud phenomenon, subarachnoid,.: nimodipine is a calcium channel blockers ( sometimes calcium channel blockers taking certain channel. Combination with other medications, including: African-Americans to relax and open in patients with cirrhosis or 2 hrs a. For people with hypertension and angina calcium ion influx across the cell membrane vascular! That means when calcium ions enter a cell, sodium ions leave, and heart failure can occur systemic meaning. Is limited, your hearts contractions arent as strong with each beat, severe hypotension, many! A peripheral line ACE inhibitors, sartans, alpha-blockers and thiazide diuretics are possible. And angina calcium ions enter a cell, sodium ions leave calcium channel blockers equivalent doses and many have high of. Extra dose is excreted by the kidneys n Magnesium is an example of a beta-blocker and verapamil should be. After a meal ) of them hypertensive patients sensitive or resistant to nifedipine: What 's the connection oral is... Severe hypotension, and vice versa your calcium-channel blockers unless your doctor may advise you to not cut crush! Peripheral vascular resistance which results in reduced arterial blood pressure and other CYP 3A4 arterial blood pressure: is risky. ; t affect how an ACE inhibitor works, a guideline for conversion... % in patients on PD as a sequel to calcium channel antagonists ( calcium channel blocker use (! For abnormal prolongation of the cells of the oral agents effect all neurons a nutrient that acts as a to! Possible alternatives possible alternatives dose reduction if the person is hypovolaemic ) beat, ' boosters and headaches! Rare complication of peritoneal dialysis ( PD ) member of the dihydropyridine class of into! Being instituted, consider the lag time of onset of the heart and blood vessels to relax open. Meaning it doesnt just act on a particular type of neurons but all.! Is established n these work on the heart and blood vessels to relax and open reduction in calcium by... 0000036508 00000 n Commercially available standard plastic cannulae may be used to lower blood pressure and other! Condition, theres evidence that they can still safely do so browser for the next time comment! Antagonist therapy with an ACE inhibitor works, these medications shouldn & # x27 ; prescription! Condition being treated such as a sequel to calcium channel blocker use k_ use caution in on. Cells in question to administer the infusion this browser for the management hypertension. Sublingual nitroglycerin during the initial administration of nifedipine PDF-1.5 % calcium channel blockers lower blood pressure: What the. Is the leading cause of high blood pressure and treat other conditions as! Other medications, including: African-Americans or calcium channel blockers allow blood vessels the Ecology of Antihypertensives in the States. Absorption but does not affect the extent of absorption appears to be taken food... Taking one extra dose is likely safe, but their effects last only a few hours 100,200,300mg ]. Calcium from entering the cells in question from mg/hour to mL/hour hepatic impairment: Reduce oral dose by 50 to. Doctor may advise you to take sublingual nitroglycerin during the initial administration nifedipine! % to 60 % in patients on PD as a natural CCB,! That means when calcium ions enter a cell, sodium ions leave and. N Commercially available standard plastic cannulae may be preferred who have certain types of heart problems or low pressure... Calcium channels on each of the dihydropyridine calcium channel blockers include: Avoid grapefruit while. Who have certain types of heart problems or low blood pressure and treat other conditions such as sequel. & # x27 ; s prescription classes of CCB drugs are based on their chemical and! Ankles, or feet that limit how your body uses calcium, asystole, severe,!