Anti-hypersensitive - calcium channel blockers Flashcards

1
Q

Calcium is released into the smooth muscle of the blood vessels which contribute to vasoconstriction. What is the mechanism of action of Ca+ channel blockers?

1 - binds and inhibits angiotensin II receptors
2 - inhibits ACE
3 - inhibit beta receptors
4 - binds and inhibits L-type Ca2+ channels

A

4 - binds and inhibits L-type Ca2+ channels

  • non competitive antagonist
  • ⬇️ Ca2+ in vascular and cardiac cells and inhibit vasoconstriction so good for blood pressure
  • reduces Ca2+ released into myocytes lowering force of contraction
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2
Q

Which of the following are calcium channel blocker medications that we need to know from our core drug list?

1 - Ramipril, Diltiazem, Verapamil
2 - Amlodipine, Ramipril, Verapamil
3 - Amlodipine, Bisoprolol, Verapamil
4 - Amlodipine, Diltiazem, Verapamil

A

4 - Amlodipine, Diltiazem, Verapamil

  • remember DAV
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3
Q

Which of the following drugs is the first line drug for hypertension, using the cuts offs below in a patient aged >55 y/o and black ethnicity?

  • Stage 3: SBP >180 mmHg Treat immediately
  • Stage 2: BP >160/100 mmHg Treat once confirmed on 24hr BP
  • Stage 1: BP > 140/90 mmHg Treat if end-organ damage or if diabetic

1 - ace inhibitors (ACE-I)
2 - calcium channel blockers
3 - alpha blockers
4 - angiotensin receptor2 blockers

A

2 - calcium channel blockers

  • Amlodipine, Diltiazem, Verapamil
  • remember DAV
  • essentially when an ACE-I or ARB-II are unsuitable
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4
Q

Calcium channel blockers (CCB) are indicated in patients with ischaemic heart disease. There are 2 types of CCB:

  • dihydropyridines
  • nondihydropyridines

Which of these acts predominantly on vascular cells and which acts predominantly on cardiac cells?

A
  • dihydropyridines =
    vascular cells
  • nondihydropyridines = cardiac cells
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5
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Which of these 3 drugs is a dihydropyridines, and preferrentially targets the vasculature cells?

1 - Amlodipine
2 - Diltiazem and Verapamil
3 - Amlodipine and Diltiazem
4 - all 3 drugs

A

1 - Amlodipine

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6
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Which of these 3 drugs is a non-dihydropyridines, and preferentially targets the cardiac cells?

1 - Amlodipine
2 - Diltiazem and Verapamil
3 - Amlodipine and Diltiazem
4 - all 3 drugs

A

2 - Diltiazem and Verapamil

  • varapamil is the most cardioselective
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7
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Which of these 3 drugs is indicated in controlling heart rate in patients with supraventricular arrhythmias, including atrial fibrillation, atrial flutter and supraventricular tachycardia?

1 - Amlodipine
2 - Diltiazem and Verapamil
3 - Amlodipine and Diltiazem
4 - all 3 drugs

A

2 - Diltiazem and Verapamil

  • most cardiac cell specific
  • varapamil is the most cardioselective
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8
Q

Verapamil and Diltiazem are the two most cardiac selective calcium channel blockers. Which of the following is NOT an affect they have on the heart?

1 - suppress cardiac conduction, particularly across the AV node
2 - reduce ventricular rate
3 - increase contractility
4 - reduce afterload and therefore myocardial oxygen demand

A

3 - increase contractility

  • they actually reduce contractility
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9
Q

In addition to vascular and cardiac effects, which of the following can Ca2+ channel blockers be used to treat?

1 - Angina
2 - Raynaud’s syndrome
3 - Arrhythmias
4 - all of the above

A

4 - all of the above

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10
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Amlodipine is a dihydropyridines, and preferentially targets the vascular cells. Which of the following is NOT a common adverse effect of Amlodipine?

1 - dehydration
2 - flushing
3 - headaches
4 - palpitations
5 - ankle swelling

A

1 - dehydration

  • ankle swelling is the most common
  • adverse events are due to the vasodilatory effect and compensatory tachycardia
  • Diltiazem can affect cardiac and vascular cells, so can cause these effects
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11
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Verapamil is a non-dihydropyridines, and preferentially targets the cardiac cells. Which of the following is NOT a common adverse effect of Verapamil?

1 - constipation
2 - heart block
3 - cardiac failure
4 - ankle swelling
5 - bradycardia

A

4 - ankle swelling
- not common with verapamil

  • Diltiazem can affect cardiac and vascular cells, so can cause these effects
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12
Q

Verapamil and diltazem should be used with caution in patients with impaired left ventricular function. Why is this?

1 - precipitate or worsen heart failure
2 - vasodilatory affects increase pressure on heart
3 - increase SVR and therefore the pressure on the heart
4 - damage the aortic valve

A

1 - precipitate or worsen heart failure

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13
Q

Verapamil and diltazem should be avoided in patients with AV nodal block. Why is this?

1 - can cause flushing
2 - can cause headaches and increase heart rate
3 - can cause heart block
4 - increase SVR and therefore the pressure on the heart

A

3 - can cause heart block

  • if AV node conduction is slow already, Verapamil and diltazem could make it worse
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14
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Amlodipine is a dihydropyridines, and preferentially targets the vascular cells. Why should Amlodipine be avoided in unstable angina patients?

1 - elicit vasodilatory effect and compensatory tachycardia
2 - can cause headaches and increase heart rate
3 - can cause heart block
4 - increase SVR and therefore the pressure on the heart

A

1 - elicit vasodilatory effect and compensatory tachycardia

  • causes tachycardia and increased contractility, increasing cardiac oxygen demand
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15
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Amlodipine is a dihydropyridines, and preferentially targets the vascular cells. Why should Amlodipine be avoided in patients with severe aortic stenosis?

1 - elicit vasodilatory effect and compensatory tachycardia
2 - can cause vasodilation and patients collapse
3 - can cause heart block
4 - increase SVR and therefore the pressure on the heart

A

2 - can cause vasodilation and patients collapse

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16
Q

There are 3 key calcium channel blockers that we need to be aware of: Amlodipine, Diltiazem, Verapamil. Verapamil and Diltiazem are non-dihydropyridines, and preferentially targets the cardiac cells. These drugs should not be used in conjunction with which other class of anti-hypertensives?

1 - ACE inhibitors
2 - Angiotensin-II receptor blockers
3 - α-blockers
4 - β-blockers

A

4 - β-blockers

  • non-dihydropyridines and B-blockers are negatively inotropic and chronotropic
  • inotropic affects contractility of the heart
  • chronotropic affects the rate of the heart
  • together both could cause heart failure, bradycardia or asytole and should only be used under close supervision
17
Q

What is the standard dose patients are prescribed amlodipine for hypertension?

  • OD = once daily

1 - 1-5mg OD
2 - 5-10mg OD
3 - 20-30mg OD
4 - 50mg OD

A

2 - 5-10mg OD

18
Q

What is the standard dose patients are prescribed diltiazem for angina?

  • MR = modified release

1 - 9mg 12/h MR
2 - 30mg 12/h MR
3 - 50mg 12/h MR
4 - 90mg 12/h MR

A

4 - 90mg 12/h MR

19
Q

What is the standard dose patients are prescribed verapamil for supreventrivcular tachycardia?

1 - 4-20mg 8/h
2 - 30-50mg 8/h
3 - 50-90mg 8/h
4 - 40-120mg 8/h

A

4 - 40-120mg 8/h