Calcium Channel Blocker Flashcards
what is the brand name for amlodipine?
Norvasc
what class are the following medications: amlodipine felodipine nifedipine verapamil
calcium channel blockers
amlodipine dosage forms?
tablet: 2.5 mg, 5mg, 10mg
amlodipine indications?
HTN and angina:
HTN: Children 6-17 y of age, 2.5-5 mg po daily; Adults, 5-10 mg po daily
Stable angina: 5-10 mg po daily
Variant angina: 5-10 mg po daily
Amlodipine MOA?
long-acting dihydropyridine calcium-channel-blocking drug with potent arterial and coronary vasodilating properties
Amlodipine contraindication?
hypersensitivity to amlodipine
Amlodipine ADR?
Common: peripheral edema and pulmonary edema
Less common: Abdominal pain, arthralgia, constipation, dizziness, fatigue, flushing, headache, hypotension, hyperkalemia, impotence, myalgia, nausea, palpitations, pruritus, rash, tachycardia, urticaria
Serious: Hepatotoxicity, thrombocytopenia, AMI, angina
Efficacy Monitoring Parameters for Amlodipine?
Decreased BP, reduction in chest pain, decreased number of weekly angina attacks, reduction in use prophylactic nitroglycerin to relieve chest pain, improvement in signs/symptoms of heart failure
Amlodipine Key counseling?
Instruct patient to report signs/symptoms of hypotension or exacerbation of angina with initial dosing and dose changes.
Avoid alcohol while taking drug.
Report signs/symptoms of peripheral edema, fatigue, hypotension, or hepatic dysfunction. This medicine may cause dizziness.
Avoid activities that could be dangerous if dizziness occurs at initiation of therapy.
Dizziness may be worse if too much water is lost from the body due to excessive sweating, diarrhea, or vomiting.
Diltiazem— Brand name?
Cardizem, Cartia XT, Dilacor XR, Dilt-XR, Taztia XT, Tiazac
Diltiazem Dosage form?
Oral tablet: 30mg, 60mg, 90mg, 120mg
Oral tablet ER: 120mg, 180mg, 240mg, 300mg, 360mg, 420mg
Oral capsule ER 12hr: 60mg, 90mg, 120mg
Oral capsule ER 24hr: 120mg, 180mg, 240mg, 300mg, 360mg, 420mg
Diltiazem Indication?
HTN: 60-120 mg (extended release, 12 h) po bid, may titrate to 360 mg/d po; 120-240 mg (extended release, 24 h) po daily, may titrate to 540 mg po daily
Stable, chronic angina: 30 mg (immediate release) po qid, may titrate to 360 mg/d po; 120 mg (extended release, 24 h) po daily, may titrate to 540 mg/d po
Atrial arrhythmia and paroxysmal supraventricular tachycardia: 180-360 mg po daily (frequency of dosing based on formulation)
Off-Label Uses.
Diltiazem Contraindication
Hypersensitivity to diltiazem, hypotension, 2nd/3rd degree AV block, sick sinus syndrome
diltiazem efficacy monitoring parameters?
Decreased BP, reduction in chest pain, decreased number of angina attacks, reduction in use of nitroglycerin for chest pain
Diltiazem counseling points?
Report symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope.
This drug is available in multiple brand names with varying properties by brand. Instruct patient to follow administration instructions specific to the prescribed brand with regards to meals and timing.
Do not drink alcohol while taking this drug.
Some products may be opened and sprinkled on a spoonful of applesauce (applesauce should not be hot, and should be swallowed without chewing, followed by a glass of water).
Administer at same time of day, either morning or evening.
Felodipine —- Brand Name and class?
Brand name: Plendil
Class: calcium channel blocker and dihydropyridine
Felodipine—- dosage form?
Oral tablet, ER
Felodipine—- Indication?
HTN: 2.5-5 mg po once daily, may increase to 10 mg po once daily
Felodipine—–MOA?
dihydropyridine calcium-channel-blocking drug with potent arterial and coronary vasodilating properties.
A reflex increase in sympathetic tone (in response to vasodilation) counteracts the direct depressant effects on SA and AV nodal conduction. This renders felodipine ineffective in the treatment of supraventricular tachycardias
Felodipine—- Contraindiction?
hypersensitivity to felodipine
Felodipine —— ADR?
Common: Headache, peripheral edema
Less common: Abdominal pain, arthralgia, constipation, dizziness, fatigue, flushing, hypotension, hyperkalemia, impotence, myalgia, nausea, palpitations, pruritus, rash, tachycardia, urticaria
Serious: Hepatotoxicity, thrombocytopenia
Felodipine—– Efficacy monitoring parameters?
Decreased BP, reduction in chest pain, decreased number of weekly angina attacks, reduction in use of prophylactic nitroglycerin to relieve chest pain
Felodipine —-Key counseling points?
Report signs/symptoms of hypotension or exacerbation of angina with initial dosing and dose changes; report signs/symptoms of peripheral edema, fatigue, hypotension, or hepatic dysfunction.
Take at the same time each day.
Avoid excessive grapefruit and grapefruit juice.
Do not discontinue drug abruptly as this may cause rebound HTN.
This medicine may cause dizziness.
Avoid driving, using machinery, or doing anything else that could be dangerous if not alert.
Dizziness may be worse if too much water is lost from the body due to excessive sweating, diarrhea, or vomiting.
Nifedipine—- Brand name and class?
Adalat CC, Procardia XL
Dihydropyridine calcium channel blocker
Nifedipine—- dosage form?
oral tablet ER 24h: 30mg, 60mg, 90mg
oral capsule: 10mg, 20mg
Nifedipine— indications?
HTN: Adults, extended release, 30 mg po daily, may titrate to 90 mg/d po (Adalat CC) or 120 mg/d po (Procardia XL); Children, 0.25 mg/kg po daily in 1 or 2 divided doses, may titrate to 3 mg/kg/d po (max 180 mg/d)
Stable chronic angina: Immediate release, 10-20 mg po tid, may titrate to 20-30 mg po 3-4 times/d, max 160 mg/d; extended release, 30-60 mg po daily, may titrate to 120 mg/d po
Variant angina: Immediate release, 5-20 mg pot id; extended release, 30-60 mg po daily, may titrate to 120 mg/d po
Nifedipine— MOA?
Nifedipine is a calcium ion influx inhibitor that selectively inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle. Nifedipine does not alter serum calcium concentrations.
Nifedipine– contraindications?
Hypersensitivity, cardiogenic shock, STEMI, concomitant use of CYP3A4/5 inducers
Nifedipine —– efficacy monitoring parameters?
BP, reduction in chest pain, decreased angina attacks, reduction is usage of nitroglycerin to relieve chest pain
Nifedipine —- counseling points?
Take Adalat CC on an empty stomach.
Report signs/symptoms of hypotension, exacerbation of angina, peripheral edema, fatigue, or hypotension.
Avoid sudden discontinuation of drug as this may cause rebound HTN.
May cause dizziness; avoid driving or using hazardous machinery until effects are known.
Avoid grapefruit juice. May see tablet or shell of dosage form in stool.
Nifedipine—– ADR?
Common: flushing, headache, dizziness, weakness, nausea, dypepsia
Less common: muscle cramps, edema, nervousness, palpitation, dyspnea, constipation
serious: aplastic anemia , thrombocytopenia, angina, AMI
Verapamil —- Brand and class?
Calan SR and Calan
Calcium channel blocker
Verapamil dosage form?
oral tablet
oral tablet ER
oral capsule ER 24h
Verapamil —– indications?
Angina: Immediate release, 80-120 mg po tid; extended release, 180 mg po daily hs, may titrate to 480 mg po daily
Atrial arrhythmia or paroxysmal supraventricular tachycardia prophylaxis: Immediate release, 240-320 mg/d in 3-4 divided doses, may titrate to 480 mg/d in nondigitalized patients
HTN: Immediate release, 80 mg po tid, may titrate to 360-480 mg/d; extended release, 180-200 mg po daily hs, may titrate to 400-480 mg po daily; extended release, 180 mg po daily in AM, may titrate to 240-480 mg/d
Verapamil —- Containdication?
Hypersensitivity to verapamil; symptomatic hypotension (systolic BP <90 mm Hg); 2nd- or 3rd-degree AV heart block, sick sinus syndrome; severe left ventricular dysfunction (ejection fraction <30%), atrial fibrillation/flutter associated with accessory bypass tract
Verapamil– ADR?
Common: ginival hyperplasia
Less common: Bradyarrhythmia, constipation, dizziness, fatigue, headache, hypotension, indigestion, nausea, palpitations, peripheral edema, rash, syncope, elevated liver enzymes
Serious: Congestive heart failure, heart block, hepatotoxicity, pulmonary edema
Verapamil– Efficacy monitoring parameters
Decreased BP, improvement in HR and rhythm, reduction in chest pain, decreased number of weekly angina attacks, reduction in use of nitroglycerin for chest pain.
Verapamil —— counseling points?
Do not crush or chew extended-release products.
Contents of extended-release capsules may be sprinkled on food and swallowed without chewing, followed by water.
Report symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope.
Avoid sudden discontinuation of drug, as this may precipitate hypertensive rebound/crisis. Rise slowly from a sitting or lying position to avoid dizziness.
Avoid alcohol and grapefruit juice.
