CCBs Flashcards Preview

CV PHARM...Antianginal > CCBs > Flashcards

Flashcards in CCBs Deck (13)
Loading flashcards...
1

Use-dependent binding to L-type calcium channels

Non-dihydropyridines
targets cardiac cells

can only attach to inside calcium channel when it's in its open conformation
--very rapid depolarization and repolarization in heart, so channel opens more frequently
--more opportunity for binding!

2

Voltage-dependent binding to L-type calcium channels

dihydropyridines
targets smooth muscle

Much slower depolarizations and repolarizations
--DHP don't require open channel, but they do require certain voltage
--b/c smooth muscle spending a lot more time at certain voltage (it's slow), more opportunity for DHP to bind

3

Non-Dihydropyridines

direct effects predominate

decrease:
--HR
--contractility
--AV conduction rate

--> reduces demand and prevents/ reverses vasospasm


Don't combine with Beta Blockers!!

4

Dihydropyridines

more potent vasodilators-->reflex cardiac stimulation

direct and indirect effects balanced

Reduces demand by reducing afterload
increases supply by coronary vasodilation

Combine w/ Beta Blockers!!!

5

Nifedipine
Felodipine
Amlodipine

arterial vasodilation!

6

Verapamil
Diltiazem

minimal arterial vasodilation

Negative chronotropic and inotropic effects
(especialy verapamil!)

7

DHP adverse effects

excessive vasodilation...

peripheral edema (b/c increased precapillary dilation)

paradoxical exacerbation of angina
(dilated skeletal muscle vessels stealing all supply from coronary vessels...decreased supply)

8

Non-DHP adverse effects

bradycardia
asystole
AV block

**contraindicated in HF!

pregnancy category C

9

Highly effective agents for relief in...

exertional and vasospastic angina

10

In pts w/ CAD, CCBs...

fail to prevent reinfarctions or CHD death
Impaired LV function...increases mortality
BBs are better

11

CCBs in HTN

higher rates of MI, HF (immediate release)

less CV events (slow-release)

12

CCBs in cancer

may inhibit apoptosis

13

Best class for treatment of angina

BBs
(unless they aren't tolerated)

or possibly added on to BB + nitrate if angina still not controlled