Ca Channel Blockers

Question 1

Primary use of Ca Channel Blockers will be in what 3 areas?

Answer 1

Angina, selected arrhythmias, HTN

Question 2

If specific to myocardium, they have what affects on inotropy, chronotropy and blood pressure?

Answer 2

decrease inotropy
decrease chronotropy
decrease blood pressure

Question 3

if specific to vasculature, they have what effect?

Answer 3

vasodilate
no effect on heart
decrease BP

Question 4

All CCBs are ____ absorbed and primarily metabolized by what?

Answer 4

well

liver (not affected by kidney disease)

Question 5

What are the 3 classes of CCBs?

Answer 5

Phenylalkylamines (verapamil)
Benzothiazepine (diltiazem)
Dihydropyridines (nifedipine, amlodipine)

Question 6

Verapamil = ___ heart and ___ vasculature.

Is it old or new?

Answer 6

95% heart, 5% vasculature

OLD- cheap

Question 7

Diltiazen = ___ heart and ___vasculature.

Answer 7

50% heart, 50% vasculature

Question 8

Nifedipine = ____heart and ___ vasculature.

Answer 8

5% heart, 95% vasculature

Question 9

Amlodipine = ___ heart and ___ vasculature.

Is it old or new?

Answer 9

% heart, 99% vasculature

new-$$$

Question 10

Is V, D, N, or A the most safe for heart failure?

Answer 10

V is worst, A is best

Question 11

which CCBs are used for tachy-arrhythmics?

Answer 11

V and D because they are negative ino/chronotropy

Question 12

How do CCBs affect coronary blood flow?

Answer 12

They all increase. Dihydro- the best.

Question 13

How does verapamil work? In what patients should you use this cautiously?

Answer 13

Effectively prolongs AV node conduction. So, decrease HR. Be cautious with those with bradycardia.

Question 14

What are AE’s of verapamil?

Answer 14

hypotension, CHF, peripheral edema (Cardiogenic), constipation

Question 15

Which class does Covera HS belong in? What does HS indicate?

Answer 15

Verapamil (phenyl…)

HS- at bedtime for circadian dosing (so that it has an effect in the morning when BP is the highest)

Question 16

T or F: Verapamil SR products should be taken with food or crushed.

Answer 16

Should be taken with food and NOT crushed.

Question 17

General rule: always start with ________ release, QID,

Answer 17

immediate

Question 18

Injectiable Diltiazem is most commonly used for______.

Answer 18

A Fib.

Question 19

What are the AE’s of Diltiazem?

Answer 19

bradycardia, rare AV block, peripheral edema (cardiogenic), flushing

Question 20

Cardizem SR are dosed ______., and Cardizem CD are dosed ____. These are both what class of CCBs?

Answer 20

SR- BID
CD-QD
Diltiazem

Question 21

How do you convert from IV to PO Diltiazem?

Answer 21

Use IR PO dosage form and overlap by about 3 hours

Question 22

Nifedipine has what AEs?

Answer 22

flushing/rash, peripheral edema (non-cardiogenic), dizziness, gingival hyperplasia (rare and also caused by anti-convulsants).

Question 23

How if Nifedipine available?

Answer 23

PO

Question 24

How is Diltiazem available?

Answer 24

IR, injectable, IV

Question 25

Nifedipine has what other potential uses?

Answer 25

migraine prophylaxis, achalasia (increased LES tone), Raynaud’s phenomenon

Question 26

Amlodipine has what AEs?

Answer 26

peripheral edema (non-cardiogenic), flushing

Question 27

How is amlodipine available?

Answer 27

PO

Question 28

What are some other CCBs?

Answer 28

Nimodipine–cerebral vasodilator (stroke)

Question 29

Which CCBs may cause SOB when lying down?

Answer 29

V and D

Question 30

How is Verapamil dosed?

Answer 30

IR PO TID

Question 31

How do CCBs work?

Answer 31

inhibit Ca++ entry into cells necessary for contraction.