Ca Channel Blockers

Question 1

Angina

Answer 1

Clinical manifestation of ischemia

Question 2

Stable Angina (what it is, cause, treatment)

Answer 2

Exertional angina from increase in chronotropy and ionotropy. Usually from >70% blockage. Can stent for symptomatic, won’t reduce M&M

Question 3

Unstable Angina (what it is, cause, and treatment)

Answer 3

Rest pain/increase in freq w/ minimal activity. Usually 30-40% block, but very irregular w/ clumps and fat outgrowths. Treat w/ statins

Question 4

Accelerating Angina

Answer 4

Worsening pattern but still exertional from big block

Question 5

Printzmals Angina

Answer 5

Spasm of a coronary, often genetic

Question 6

Angina of HTN

Answer 6

Increased afterload and LVH increases demand so much that normal supply just can’t keep up

Question 7

Angina of Aortic Stenosis

Answer 7

Increased demand/afterload/LVH, but also maybe decreased supply to coronaries

Question 8

Nitrates

Answer 8

Huge venodilators, so systemic return to the heart decreases so POTENT PRELOAD REDUCERS. May also reduce afterload and increase coronary supply

Question 9

2 Effects of Ca Blockers

Answer 9

Vasodilate and decrease ionotropy

Question 10

Preactivated State

Answer 10

More effective to block conduction than reducing Ca influx is to block Ca channels from reverting to preactivated state

Question 11

Nondihydropyridine (effect, mech, 2 examples)

Answer 11

Delay preactivated state so they slow node conduction and decrease ionotropy, causing decreased HR, contractility, and causing vasodilation
Verapamil and Diltiazem (Cardiazem)

Question 12

Dihydropyridines (point about mech, and effects, 5 points total)

Answer 12

Don’t block preactivated state, so little to no effect on conduction or contractility, but VERY POTENT VASODILATORS D IS FOR DILATE. But also increase CATs!

Question 13

4 Dihydropyridines

Answer 13

Nifedipine - very strong
Nicardipine - similar but IV
Amlodipine, Felodipine are long acting

Question 14

Main Summary of Nons and Dis

Answer 14

Nons relax heart and dilate

Dis dilate and either nothing on heart or increase via CATs

Question 15

Huge Drug-Drug Interaction w/ Nons

Answer 15

DO NOT USE VERAPAMIL AND BETA BLOCKERS. Heart block and severe bradycardia from the multiple sources slowing conduction and heart activity (can use diltiazem cautiously)

Question 16

Huge Drug-Drug Rule with Dis

Answer 16

Short acting nifedipine causes increased death in CAD/anginal patients (maybe form increased CATs). So if you need to use it to control HTN, use LONG ACTING WITH BETA BLOCKERS

Question 17

IV or PO

Answer 17

If patient is symptomatic (having acute attack), use IV