CCB

Question 1

Not used in

Answer 1

—-NOT RECOMMENDED IN STEMI. CCBs INCREASE morbidity/mortality in STEMI.
May used only cautiously to relieve ischemia or control AF if B-Blockers contraindicated. Consider LOW DOSE of Diltiazem with HR monitoring.
—-Heart Failure HF: Non DHPCCB is an exacerbation factors due to its Negative Inotropes effect

Question 2

Nonselective: Propranolol
Selective: Atenolol & Metoprolol /////antiarrhythmics(esp. Amiodarone)//////// anesthetics ++++++ cardiodepressant effects

Answer 2

Nonselective: Propranolol
Selective: Atenolol & Metoprolol ///////////Digoxin +++++++++ Non DHP CCBs.— dose must be halved—else bradycardia

Question 3

Long-acting dihydropyridine CCBs can be used as an first-line antihypertensive agents.

Answer 3

Dihydropyridine CCBs:First-line agents in primary and secondary Raynaud phenomenon.If not well tolerated, nondihydropyridine CCBs may be considered, but less effective

Question 4

Non DHP CCBs
Verapamil,
Deltiazem

Answer 4

Bradycardia, hypotension, constipation, flushing.

Question 5

Verapamil interaction by metabolism

Answer 5

Metabolism: N-dealkylation via

i) CYP3A4 and may decrease clearance of lovastatin, sildenafil, zolpidem,Colchicine—Colchicine toxicity:GI symptom,fever,leukopenia
ii) CYP2C9
iii) CYP1A2 (inhibitor effect)

Question 6

Diltiazem:

Answer 6

inhibitors of CYP3A4: ↑ lurasidone (antipsychotic) levels

Inhibitors of CYP1A2:↑ Clozapine