Calcium Channel Blockers Flashcards
What is the largest family of calcium channel blockers? What are examples of them?
Dihydropyridines (Nifedipine, Amlodipine, Nicardipine, Nimodipine)
What does dihydropyridine mainly act upon?
Blood vessels
What does nondihydropyridines affect? What are examples of this class?
The heart and blood vessels. Verapamil and diltiazem
What are therapeutic uses of Verapamil?
Vasospastic angina and angina of effort because of the benefit of vasodilation. It is a second line agent for chronic HTN.
What is the most common SE of Verapamil? What are other SE?
Most common: constipation which is a result of the blockade of calcium channels in the smooth muscle of the intestine
Other SE: dizziness, facial flushing, headache, and edema of the ankles/feet (caused by vasodilation).
Verapamil should be used with caution in patients with what condition? When should it be avoided?
Use with caution in HF. Avoid use in patient with SSS or second/third degree AV block.
This is because in the SA node, the calcium channel blockade cause bradycardia; in the AV node, it can cause partial or complete AV block; and decrease contractility in the myocardium.
When Verapamil is used with ________, which also suppress impulse conduction through the AV node, the risk for AV block is increased.
Digoxin
What is the overall CV effects of verapamil?
Vasodilation accompanied by reduced arterial pressure and increased coronary perfusion.
What patient education should be provided to a patient that was prescribed verapamil?
Do not take with grapefruit juice (inhibits intestinal and hepatic metabolism which increases drug levels).
Take beta blockers several hours apart from verapamil because they have the same effects on the heart (risk for excessive cardiac suppression).
What skin condition can occur in older adults taking Diltiazem?
Chronic eczematous rash
What are the uses for Diltiazem? Adverse effects?
Used for angina pectoris, essential HTN, and cardiac dysrhythmias.
AE: dizziness, flushing, headache, edema in ankles/feet, eczematous rash
What is the onset and peak of diltiazem?
Onset within minutes. Peak within 30 minutes
What is the onset and peak of verapamil?
Onset within 30 minutes. Peak within 5 hours.
How is Verapamil excreted?
Primarily by hepatic metabolism. Reduce dose in patients with hepatic impairment
What are effects of dihydropyridines? Adverse effects?
Lowers BP, increase HR, increase contractility
AE: flushing, dizziness, headache, peripheral edema, gingival hyperplasia, chronic eczematous rash in older adults.
