Flashcards in CCBs Deck (24):
How do CCBs work?
They inhibit calcium entry into contractile cells
How are CCB's metabolized?
Hepatically (well absorbed)
What is the effect of vascular specific CCB's?
Relaxation of arteriolar smooth muscle causing decreased TPR
How do cardiac specific CCB's work?
Decrease cardiac contractility and conduction
(-inotropy and -chrontropy)
What is the oldest calcium channel blocker in use and what is its mechanism?
Verapamil – inhibits entry of calcium ions through to slow channels, prolonging AV node conduction (95% effect on the heart, 5% effect on vasculature)
Which patients should avoid verapamil?
Patients with CHF or bradycardia
List 4 adverse reactions to verapamil
Hypotension, CHF, peripheral edema, constipation
What three conditions can be managed with a calcium channel blocker?
Angina, selected arrhythmias, and hypertension
What is the usual dose of verapamil? List alternatives
Immediate release 80 to 120 mg PO TID
Also comes in: IV, circadian dosing (taken at HS, $$$) or standard release (taken with food)
What should be monitored while patient takes verapamil?
Blood pressure, heart rate, EKG (PR prolongation)
Which CCB is equally specific for vasculature and myocardium?
Which form of Diltiazem (injectable or oral) is usually used to treat a fib?
List the adverse effects of Diltiazem
Bradycardia, peripheral edema, flushing, rare AV block
How is diltiazem dosed?
Start with IR 30 mg PO QID, gradually increased dose over 1-2 days until desired response is achieved (max 240 to 360 mg per day)
What is Cardizem CD?
A continuous dose of Diltiazem taken only once per day (180-240mg capsules)
How should Cardizem (Diltiazem) standard release products be taken?
Take in a.m. and do not chew or crush
Who should avoid or be extremely cautious in taking Diltiazem?
CHF patients, heart block patients, patients on beta blockers
Where are the major effects of nifedipine seen?
95% on vasculature, 5% on myocardium
What are adverse affects of nifedipine?
Flushing, rash, peripheral edema, dizziness, gingival hyperplasia
List alternative uses for nifedipine
Migraine prophylaxis, achalasia, Raynauds
Where does amlodipine have most of its effect?
99% on vasculature (very safe for CHF patients)
How often is amlodipine taken?
Only once a day (max dose to 10 mg)
Describe the difference between quality of peripheral edema as side effects of amlodipine and nifedipine, verapamil and diltiazem
Amlodipine and nifedipine – noncardiogenic peripheral edema
Diltiazem and verapamil – cardiogenic peripheral edema