Calcium Channel Blockers.txt

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Author:
Corissa.Stovall
ID:
240863
Filename:
Calcium Channel Blockers.txt
Updated:
2013-10-16 18:14:09
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Pharm Test
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Pharm Test 2
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  1. Calcium Channel blockers end in
    -pine
  2. One class of CCB is Dihydropiridines (have large or strong effect of vascular smooth muscle)
    DO NOT AFFECT CARDIAC CONDUCTION SYSTEM!!
    * This is the only class that includes more than one drug!!
    Drugs:
    • Nifedipine (Procardia)
    • Amlodipine (Norvasc)
    • Nicardipine (Cardene)
    • Felodipine (Plendil)
  3. Second class of CCB
    Phenylalkylamine- (major effect on cardiac muscle and SA and AV node conduction.
    Drug:
    Verapamil (veralin)
  4. 3rd class of CCB
    Benzothiazepine (Large effect on cardiac conduction)
    Drug??
    Dilatezem (Cardizem)
  5. 4th class of CCB - diarylaminopropylamine -- drug???
    Bepridil (vascor)
  6. Indications CCB??
    • HTN
    • vasospastic angina
    • arrhythmias
    • off label tx for stable angina and raynauds syndrome
    • effective for managing stable angina
  7. Short acting nifedipine should not ever be used:
    • ACUTE reduction of BP
    • control of essential HTN
    • Immediately after MI
    • acute coronary artery syndrome
    • *this warning applies only to nifedipine.
  8. CCB MOA???
    Block inward movement of calcium ions into slow channels of cell membranes of cardiac and smooth muscle cells (conductive and contractile)

    *(block calcium current into heart...this causes dilation if no Ca)


  9. Different CCB differ in their location of action
    1. myocardium
    2. SA and AV node
    3. Vascular smooth muscle
    • 1. decrease in Ca+ causes decrease in actin and myosin, which decreases cardiac contractility.
    • 2. Decreased automaticity of SA node, and delayed conduction of AV node.
    • 3. Dilate coronary arteries in both normal and ischemic heart--decrease PVR
  10. Dihydropiridines (nifedipine, Norvasc)
    MOA?
    Treat?
    May cause? what side effect?
    Unlike other CCB they do not alter _____?
    • Potent vasodilators of coronary and peripheral arteries.
    • Treat: HTN
    • -may cause reflex tachycardia
    • BUT REMEMBER THEY DO NOT ALTER CONDUCTION , SO THEY DO NOT SLOW SINUS RATE!!!!  Do not use with arrhythmias
  11. What is an adverse affect of CCB ???
    significant pedal edema
  12. Non-hydropyridines
    IE:
    Check for ____ before using?
    Use extreme caution with patients with_____ and ______?
    Do not use with ______ or _______?
    • DO ACT ON CONDUCTION SYSTEM
    • IE: Cardizem, and verapamil

    • Assess LV dysfunction and conduction before using these drugs, they have negative inotropic effect and can worsen preexisting LV dysfunction.
    • Extreme caution with SSS and hypotension
    • Do not use with heart block, or bradyarrhythmias.
  13. When would you not treat with a CCB?
    a. Arrhythmia
    b. Afib/ A-flutter
    c. HTN
    d. Prim. Angina
    B- afib/aflutter


    it may cause rapid ventricular response or Vfib if they have a pathway.
  14. Vaughan Williams Classification
    Class I
    Reduces phase 0 slope and peak of action potential.

    Sodium Channel Blockade
  15. Vaughan Williams Classification
    Class II
    • Beta Blockade
    • Block sympathetic activity
    • Reduce rate and conduction.
  16. Vaughan Williams Classification
    Class III
    Potassium Channel Blockers- delay repolarization( phase 3) and thereby increase action potential and refractory period.
  17. Vaughan Williams Classification
    Class IV
    • CCB
    • Block calcium channels
    •  Most effective at SA and AV nodes, reduce rate and conduction. (except dihydropyridines- they do not affect conduction ie: Nifedipine, Norvasc)
  18. Vaughan Williams Classification
    Class I, II, III, and IV
    • I- Sodium Channel blockers
    • II- Beta Blockers
    • III- Potassium Channel blockers
    • IV- CCB
  19. What are two examples of Class III Drugs?
    • sotalol
    • amiodarone
  20. What is the first line treatment for Chronic Stable Angina??
    Nitrates and Bblockers
  21. Do not use nondihydropyridines with _______ or _________?
    heart block or bradyarrhythmias
  22. Dihydropyridines have no effect on _______?
    Cardiac Conduction

    Unlike the other CCB's
  23. Nondihydropyridines have significant effect on __________?
    And are used to treat ______ and _______?
    • cardiac conduction
    • arrhythmias and HTN
  24. What is the first line treatment for Stage 1 HTN?
    thiazide diuretics
  25. What is the recommended treatment for Stage 1 uncontrolled or Stage II HTN?
    nitrates and BB
  26. CCB are for patients that can not tolerate  _____ or _____ or they are not controlled with a combination of drugs for angina.
    beta blockers or nitrates.
  27. CCB are the drug of choice for ______ over beta blockers because they reduce BP more effectively
    African Americans

    and thiazide diuretics
  28. What does verapamil and Cardizem treat?
    (nonhydropyridines)
    Less likely to cause ____ than hydropyridines
    Use caution with what other drug ____?
    Not recommended with what disease process ______?
    Does not improve _______?
    arrhythmias, and HTN

    • Less likely to cause hypotension than hydropyridines
    • Use caution with BB because they also decrease conduction
    • Not recommended with heart failure.
    • Do not improve exercise intolerance.
  29. CCB DOC IN
    Prinzmetals angina

    Also may want to use CCB with patient with chronic NSAID use.
  30. CCB's relieve _____ and help improve ______?
    • angina
    • exercise intolerance (except Cardizem and verapamil)
  31. ADR of CCB (two most common)
    • pedal edema- (on test elderly women with pedal edema)
    • headache
  32. May want to use ______ with patients that have chronic NSAID use!!
    CCB's

    effective of CCB is not blunted by NSAID use!
  33. Taper CCB dosage off over ____ weeks.
    May cause increased duration and frequency of _____ if not tapered.
    • 4 weeks
    • Chest pain
  34. Do not drink ________ with CCB's because it decreases effectiveness.
    Grapefruit juice.
  35. CCB increase the effects of what 4 drugs?
    dig, statin, bblockers, theophylline

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