1. CCBs

Question 1

MOA for CCBs (DHPs vs non-DHPs)

Answer 1

Both: act on the slow L-type voltage gated channels, preventing the influx of calcium in the vasculature leading to peripheral vasodilation
Non-DHPs are negative inotropes, decreasing contraction force, and negative chronotropes, decreasing HR (act on the slow L-type calcium channels on the myocardium during depolarization)

Question 2

amlodipine (brand, dosing)

Answer 2

Norvasc

2.5-10 mg daily

Question 3

felodipine (brand, dosing)

Answer 3

Plendil

2.5-10 mg daily

Question 4

isradipine (brand, dosing)

Answer 4

generic only

2.5-10 mg BID

Question 5

nifedipine ER (brand, dosing)

Answer 5

Adalat CC, Afeditab CR, Nifediac CC, Nifedical XL, Procardia XL
30-90 mg/day

Question 6

nisoldipine ER (brand, dosing)

Answer 6

Sular: 8.5-34 mg/day

Originial formulation: 10-60 mg/day

Question 7

nicardipine (brand for ER & IR, dosing)

IV formulation available

Answer 7

ER: Cardene SR
30-60 mg BID

IR: Cardene
20-40 mg TID

Question 8

clevidipine injection

Answer 8

Cleviprex

1-21 mg/hr

Question 9

CCB DHP warnings (2)

Answer 9

–inc. angina and/or MI has occurred with initiation or dosage titration
–use with caution in pts w/ aortic stenosis; may reduce coronary perfusion resulting in ischemia

Question 10

CCB DHP SEs

Answer 10

Peripheral edema, fatigue, dizziness, headache, palpitations, flushing, (reflex) tachycardia, hypotension, gingival hyperplasia

Question 11

CCB DHP monitoring

Answer 11

BP, HR, peripheral edema

Question 12

Do not use _______ for acute BP reduction because it is not effective as well as harmful

Answer 12

nifedipine IR

Question 13

CCBs are pregnancy category ___

Answer 13

C

Question 14

Protect ______ from light and moisture.

_____ and _____ needs light protection during administration.

Answer 14

nifedipine

Cardene IV, verapamil

Question 15

Which 3 CCBs can leave a ghost tablet in stool?

Answer 15

Adalat CC, Procardia XL and Covera HS

Question 16

Which 2 DHPs are considered the safest in patients with HFrEF?

Answer 16

amlodipine and felodipine

Question 17

clevidipine CIs (4)

Answer 17

–soy or egg allergy
–acute pancreatitis
–severe aortic stenosis
–lipoid nephrosis

Question 18

clevidipine SEs

Answer 18

headache, N/V

rare: hypertriglyceridemia, infections

Question 19

clevidipine monitoring

Answer 19

BP, HR

Question 20

clevidipine is a lipid emulsion (provides 2 kcal/mL); it is ________ in color

Answer 20

milky-white

Question 21

clevidipine requires strict ______ technique upon administration due to ______ risk. Max hang time per vial/bottle is ____.

Answer 21

aseptic; infection; 12 hrs

Question 22

What are the non-DHPs?

Answer 22

diltiazem, verapamil

both are available in tablets, capsules and injection

Question 23

diltiazem (brand, dosing)

Answer 23

Cardizem, Cardizem CD, Cardizem LA, Cartia XT, Dilacor XR, Dilt-CD, Dilt-XR, Diltzac, Taztia XT, Tiazac
60-360 mg/day in 1-2 divided doses
Max 480-540 mg daily

Question 24

verapamil (brand, dosing)

Answer 24

Calan, Calan SR, Covera HS, Verelan, Verelan PM

240-480 mg/day in 1-3 divided doses

Question 25

non-DHP CIs (6)

Answer 25

–hypotension (SBP

Question 26

non-DHP warnings (2)

Answer 26

–first degree AV block or sinus bradycardia

–increases in LFTs

Question 27

non-DHP SEs

Answer 27

edema, headache, dizziness, bradycardia, hypotension, arrhythmias, HF, constipation (more with verapamil), gingival hyperplasia

Question 28

non-DHP monitoring

Answer 28

BP, HR, ECG, LFTs

Question 29

CCB DDIs

Answer 29

major CYP3A4 substrates and moderate CYP3A4 inhibitors