Calcium Channel Blocker

Question 1

what is the brand name for amlodipine?

Answer 1

Norvasc

Question 2

what class are the following medications:
amlodipine
felodipine
nifedipine
verapamil

Answer 2

calcium channel blockers

Question 3

amlodipine dosage forms?

Answer 3

tablet: 2.5 mg, 5mg, 10mg

Question 4

amlodipine indications?

Answer 4

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

Question 5

Amlodipine MOA?

Answer 5

long-acting dihydropyridine calcium-channel-blocking drug with potent arterial and coronary vasodilating properties

Question 6

Amlodipine contraindication?

Answer 6

hypersensitivity to amlodipine

Question 7

Amlodipine ADR?

Answer 7

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

Question 8

Efficacy Monitoring Parameters for Amlodipine?

Answer 8

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

Question 9

Amlodipine Key counseling?

Answer 9

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.

Question 10

Diltiazem— Brand name?

Answer 10

Cardizem, Cartia XT, Dilacor XR, Dilt-XR, Taztia XT, Tiazac

Question 11

Diltiazem Dosage form?

Answer 11

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

Question 12

Diltiazem Indication?

Answer 12

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.

Question 13

Diltiazem Contraindication

Answer 13

Hypersensitivity to diltiazem, hypotension, 2nd/3rd degree AV block, sick sinus syndrome

Question 14

diltiazem efficacy monitoring parameters?

Answer 14

Decreased BP, reduction in chest pain, decreased number of angina attacks, reduction in use of nitroglycerin for chest pain

Question 15

Diltiazem counseling points?

Answer 15

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.

Question 16

Felodipine —- Brand Name and class?

Answer 16

Brand name: Plendil

Class: calcium channel blocker and dihydropyridine

Question 17

Felodipine—- dosage form?

Answer 17

Oral tablet, ER

Question 18

Felodipine—- Indication?

Answer 18

HTN: 2.5-5 mg po once daily, may increase to 10 mg po once daily

Question 19

Felodipine—–MOA?

Answer 19

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

Question 20

Felodipine—- Contraindiction?

Answer 20

hypersensitivity to felodipine

Question 21

Felodipine —— ADR?

Answer 21

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

Question 22

Felodipine—– Efficacy monitoring parameters?

Answer 22

Decreased BP, reduction in chest pain, decreased number of weekly angina attacks, reduction in use of prophylactic nitroglycerin to relieve chest pain

Question 23

Felodipine —-Key counseling points?

Answer 23

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.

Question 24

Nifedipine—- Brand name and class?

Answer 24

Adalat CC, Procardia XL

Dihydropyridine calcium channel blocker

Question 25

Nifedipine—- dosage form?

Answer 25

oral tablet ER 24h: 30mg, 60mg, 90mg

oral capsule: 10mg, 20mg

Question 26

Nifedipine— indications?

Answer 26

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

Question 27

Nifedipine— MOA?

Answer 27

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.

Question 28

Nifedipine– contraindications?

Answer 28

Hypersensitivity, cardiogenic shock, STEMI, concomitant use of CYP3A4/5 inducers

Question 29

Nifedipine —– efficacy monitoring parameters?

Answer 29

BP, reduction in chest pain, decreased angina attacks, reduction is usage of nitroglycerin to relieve chest pain

Question 30

Nifedipine —- counseling points?

Answer 30

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.

Question 31

Nifedipine—– ADR?

Answer 31

Common: flushing, headache, dizziness, weakness, nausea, dypepsia

Less common: muscle cramps, edema, nervousness, palpitation, dyspnea, constipation

serious: aplastic anemia , thrombocytopenia, angina, AMI

Question 32

Verapamil —- Brand and class?

Answer 32

Calan SR and Calan

Calcium channel blocker

Question 33

Verapamil dosage form?

Answer 33

oral tablet
oral tablet ER
oral capsule ER 24h

Question 34

Verapamil —– indications?

Answer 34

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

Question 35

Verapamil —- Containdication?

Answer 35

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

Question 36

Verapamil– ADR?

Answer 36

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

Question 37

Verapamil– Efficacy monitoring parameters

Answer 37

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.

Question 38

Verapamil —— counseling points?

Answer 38

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.