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Flashcards in CCB ppt Deck (47):
1

what is the role of intracellular Ca++

regulates contraction

2

how can you tell a myocyte cell from the rest?

it has troponin c

3

how does Ca++ work in cardiac muscle

Ca++ binds to troponinC releives troponin I inhibition of actin-myocin interaction

4

how does Ca++ work in smooth muscle

binds to calmodulin causing actin and myosin interaction

5

where is most Ca++ at intracellular or extracellular?

extracellular

6

where is most of the Ca++ at intracellularly

the SR

7

Ca++ bound to SR is what

inactive

8

Free Ca++ inctracellular concentration is markedly increased when?

during contraction b/c SR releases Ca++ and the Ca++ channel is open allowing Ca++ in

9

what are the 6 types of Ca++ channels

L
N
P
Q
R
T

10

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What are the Ca++ channels we deal with ?

L
and
T

11

what type of channels are Ca++ channels

voltage gate

12

what is a voltage gated channel

when they reach a voltage then the open
(a ligand gated is a drug or hormone binding)

13

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what is the L-type channel

sustained conductance, slow inactivation

14

****
What is T-type channels

similar to L but rapid inactivation'have minimal sensitivity to CCB

15

**********
with CCB what type of channel are me using the most

L-type

16

5 subunits of L-type (slow) Ca++ channels

alpha 1
alpha 2
beta
gamma
delta

17

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3 main types of CCB then what are the real way to differentiate them into 2 goups?

Non-dihydropyridines
-Phenylalkylamines-
-Benzothiazepines-
1,4- dihydropyridines (DHPs)

18

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so basically all CCB are DHP except for what 2 drugs?

verapamil
and
diltiazem

19

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what is an example of a NonDHP phenylaklylamine and benzothiazepines

phenylaklylamine- verapamil
benzothiazepines- diltiazem
a way to try and remember
(benz=lorazepam sounds like diltazem)

20

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what is the main difference b/t NonDHP and DHP?

Non-DHP-affect nodes (both verap and diltaz)
DHP-do not effect Nodes

21

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how do phenylalkylamines work?

Verapamil
binds to intracellular portion of alpha subunit 1

22

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how do benzothiazepines work

diltiazem
MOA not understood

23

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how do DHP work

modulate the L-type channel
vascular smooth muscle

24

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should someone be on cardizen and a BB?

no b/c they both affects nodes

25

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can someone be on a BB and DHP CCB

sure the DHP CCB don't effect HR

26

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out of the drugs
Verapamil Non-DHP (phenylalkylamine)
Diltiazem Non-DHP (benzothiazepine)
Nifidipine DHP
Nicardipine DHP
which ones in order cause coronary vasodilation

Verapamil- moderate
Diltiazem - mod
Nifidipine - marked
Nicardipine **** greatest

27

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out of the drugs
Verapamil Non-DHP (phenylalkylamine)
Diltiazem Non-DHP (benzothiazepine)
Nifidipine DHP
Nicardipine DHP
whcih ones in order cause supression of cardiac contractility

Verapamil-moderate
Diltiazem -mod
Nifidipine - mod
Nicardipine -0/slight

28

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out of the drugs
Verapamil Non-DHP (phenylalkylamine)
Diltiazem Non-DHP (benzothiazepine)
Nifidipine DHP
Nicardipine DHP
which ones in order cause supression of SA node

Verapamil -mod
Diltiazem - slight
Nifidipine - none
Nicardipine - none

29

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out of the drugs
Verapamil Non-DHP (phenylalkylamine)
Diltiazem Non-DHP (benzothiazepine)
Nifidipine DHP
Nicardipine DHP
which ones in order cause supression of AV node

Verapamil - marked
Diltiazem - mod
Nifidipine - none
Nicardipine - none

30

***********
ex of DHP CCB

Nicardipine
nifedipine
nimodipine
clevidipine
amlodipine
(-pine)
(remember Ca++le graze in the -pine)

31

pharmacology of Non-DHP

Neg inotropic
Neg- chronotropic
Neg-dromotropic
positive- Lusitropic (myocardial relaxation)

32

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what do ALL CCB do pharmacology wise

-decrease coronary vascular resistance and increase coronary blood flow
-Decrease PVR via vasodilation of arterioles
- minimal venous tone effects

33

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which CCB is best for variant angia
eg vasospastic or prinzmetal's angina

Narcardapine

34

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which CCB is good for subarachnoid hemorrhage (posthemoragic cerebrovascular spasm

Nimodipine

35

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which CCB's are good for Hypertrophic cardiomyopathy

Nifidipine
verapamil

36

Common SE of CCB

-orthrostatic hypotension
-bradycardiam(DHP increase HR)
- periphreal edema
- dizziness
headaches
flushing
N/V

37

Verapamil can increase the levels of what drug

Digoxin

38

which CCB is commonly used in the OR Can be given bolus or infusion and what class

Nicardapine
DHP

39

Which CCB is very fast onset off set, faster than nicardapine, prepared in a lipid emulsion, only given in bolus no infusion?

Clevidipine

40

Contraindications to Verapimil

WPW
Sicksinus syndrome
Av block
Heart rate

41

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how do CCB decrease contraction

decrease influx of Ca++ causes decrease in contraction

42

************** basic way Non-DHP work

slow cardiac conduction
decrease HR via SA and AV nodes

43

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basic way DHP work

no effect on conduction
vasodilate
increase HR

44

***********
what CCB is the greatest coronary vasodilator and can cause coronary steal?

Nicardapine

45

Why are DHP and BB ok to use in combination

DHP incease HR and BB decrease HR

46

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why do Non-DHP slow HR

closes the Ca++ channels in phase 4 thus decreasing hr
so it basically blocks the conduction and prolongs the time it takes to reah the threshold

47

If HR is 45 and B/P is 210/105 what drug would you give

DHP like nicardapine or any
if has no effect on HR and will decrease BP