ANS Pharm: CCBs

Question 1

Answer 1

Diltiazem’s effects:

• SA node: (-) chronotrope
• AV node: (-) dromotrope
• ♡ muscle: (-) inotrope

Question 2

CCBs

Aside from (-) chronotropy & inotropy, what effects do they have?

Answer 2

• (-) dromotrope (AV)
• vasodilate
• depress baroreceptors

some also dilate coronaries & inhibit coronary spasm

Question 3

Answer 3

Question 4

T/F:
CCBs cause more relaxation in veins than arteries.

Answer 4

False

Question 5

Which CCBs are Class IV anti-arrhythmics?

Answer 5

verapamil
&
diltiazem

Question 6

When do Ca channels open and close?

Answer 6

closed during relaxation

open via voltage gated or receptor mechanism

Question 7

Answer 7

Question 8

Heart & vascular
-the 2 types of Ca Channels
-which one does CCB work on?

Answer 8

Transient (T) & Long (L)

L

Question 9

Aside from HTN and arrhythmias, what can CCBs treat?

Answer 9

• PVD
• cerebral vasospasm
• angina

Question 10

Which agents are best for:
-HR control
-contractility preservation
-HTN control

Answer 10

HR: verapamil & diltiazem

contractility: avoid verapmil; diltiazem ✅

HTN: nifedipine, nicardipine

Question 11

coronary antispasmodic

Answer 11

nicardipine

Question 12

CCBs that impair contractility greatest to least

Answer 12

1. verapamil
2. nifedipine
3. diltiazem
4. nicardipine

In a patient with decreased contractility, diltiazem is a better choice than verapamil.

Question 13

the only CCB provn to reduce morbidity & mortality from cerebral vasospasm

Answer 13

nimodipine

Question 14

T/F:
CCBs reduce preload and afterload.

Answer 14

False
preserve preload while reducing LV afterload

Question 15

CCBs & baroreceptors

Answer 15

verapamil & diltiazem = (-) chronotropes
but
other CBs may increase HR due to baroreceptor reflex-mediated tachycardia
(often give w/ beta-1 antagonist)

Question 16

highest degree of myocardial depression

Answer 16

verapamil

(angina, MI)

Question 17

T/F:
Aside from verapamil & diltiazem, CCBs have little effect on SA & AV node suppression.

Answer 17

True

Question 18

not a potent arterial vasodilator, but strong depressor of automaticity (chronotropy), conductivity (dromotropy), and myocardial contraction (inotropy).

Answer 18

verapamil

Question 19

does not provoke increases in HR secondary to its vasodilator effect due to its depression of automaticity and conductivity.

Answer 19

verapamil

Question 20

If an MI/angina patient cannot tolerate a B1B, what can we give?

Answer 20

verapamil

Question 21

What EKG change would you expect with verapamil? why?

Answer 21

prolong PR

decreases SA discharge rate & AV conduction

Question 22

What rhythms can verapamil & diltiazem treat?

Answer 22

• SVT
• AFIB
• Aflutter

Question 23

This CCB used with a B1B can cause complete heart block/profound depression

Answer 23

verapamil

Question 24

verapamil dose

Answer 24

2.5 - 10 mg over 2 minutes

titrate!
significant patient variability

Question 25

Diltiazem triggers the baroreceptor response but HR still drops. Why?

Answer 25

potent negative chronotropic and dromotropic effects on SA and AV nodes

Question 26

diltiazem dose

Answer 26

0.25 - 0.35 mg/kg over 2 minutes titrate! significant patient variability

Question 27

This CCB is highly selective for arterial smooth muscle ***without*** negative chronotropic or inotropic effects.

Answer 27

Clevidipine no effect on preload may increase CO

Question 28

clevidipine HL

Answer 28

~ 2 min

Question 29

T/F: Expect reflex increase in HR with Clevidipine.

Answer 29

True

Question 30

Clevidipine uses

Answer 30

* IV short term BP control * acute HTN (pheochromocytoma & intracerebral hemorrhage) * controlled hypotension

Question 31

Dosing of clevidipine

Answer 31

highly variable, but 1 - 2 mg/hr is common ## Footnote HL is 2 mins so gtt

Question 32

This CCB is more lipophilic than others and crosses the BBB = cerebral arterial vasodilation

Answer 32

Nimodipine

Question 33

T/F: Nimodipine can reverse cerebral vasospasm.

Answer 33

False reduces manifestations of cerebral vasospasm & may reduce cerebral arteriolar resistance and enhance collateral blood flow

Question 34

Reflex tachycardia is possible with these CCBs

Answer 34

nifedipine nicardipine clevidipine

Question 35

Nifedipine is used for essential HTN and dilates (arteries/veins/both)

Answer 35

arteries no effect on venous tone

Question 36

best CCB for Raynaud's

Answer 36

Nifedipine

Question 37

Can we give Nifedipine to an acute MI patient?

Answer 37

no may worsen mortality ## Footnote although its depressant effects are not seen at clinical doses

Question 38

give this CCB with a B1B to prevent reflex tachycardia

Answer 38

nifedipine

Question 39

T/F: Most CCBs show patient variability, so titrate doses carefully.

Answer 39

True

Question 40

Nifedipine dose

Answer 40

0.5 mg/hr titrate d/t varying response

Question 41

which has longer doA? Nifedipine or nicardipine

Answer 41

nicardipine *why its used for chronic HTN

Question 42

Dosing of nicardipine

Answer 42

5 mg/hr, titrate (patient variability) ## Footnote nifedipine: 0.5 mg/hr

Question 43

T/F: Nicardipine dilates coronaries without negative inotropy.

Answer 43

True very little/no depression

Question 44

Which CCB has least increase in coronary flow?

Answer 44

diltiazem

Question 45

T/F: Nicardipine depresses the AV node

Answer 45

False

Question 46

Does diltiazem depress the myocardium?

Answer 46

modestly

Question 47

Answer 47

clevidipine