CCB ppt

Question 1

what is the role of intracellular Ca++

Answer 1

regulates contraction

Question 2

how can you tell a myocyte cell from the rest?

Answer 2

it has troponin c

Question 3

how does Ca++ work in cardiac muscle

Answer 3

Ca++ binds to troponinC releives troponin I inhibition of actin-myocin interaction

Question 4

how does Ca++ work in smooth muscle

Answer 4

binds to calmodulin causing actin and myosin interaction

Question 5

where is most Ca++ at intracellular or extracellular?

Answer 5

extracellular

Question 6

where is most of the Ca++ at intracellularly

Answer 6

the SR

Question 7

Ca++ bound to SR is what

Answer 7

inactive

Question 8

Free Ca++ inctracellular concentration is markedly increased when?

Answer 8

during contraction b/c SR releases Ca++ and the Ca++ channel is open allowing Ca++ in

Question 9

what are the 6 types of Ca++ channels

Answer 9

L
N
P
Q
R
T

Question 10

What are the Ca++ channels we deal with ?

Answer 10

L
and
T

Question 11

what type of channels are Ca++ channels

Answer 11

voltage gate

Question 12

what is a voltage gated channel

Answer 12

when they reach a voltage then the open

a ligand gated is a drug or hormone binding

Question 13

what is the L-type channel

Answer 13

sustained conductance, slow inactivation

Question 14

What is T-type channels

Answer 14

similar to L but rapid inactivation’have minimal sensitivity to CCB

Question 15

with CCB what type of channel are me using the most

Answer 15

L-type

Question 16

5 subunits of L-type (slow) Ca++ channels

Answer 16

alpha 1
alpha 2
beta
gamma
delta

Question 17

3 main types of CCB then what are the real way to differentiate them into 2 goups?

Answer 17

Non-dihydropyridines
-Phenylalkylamines-
-Benzothiazepines-
1,4- dihydropyridines (DHPs)

Question 18

so basically all CCB are DHP except for what 2 drugs?

Answer 18

verapamil
and
diltiazem

Question 19

what is an example of a NonDHP phenylaklylamine and benzothiazepines

Answer 19

phenylaklylamine- verapamil
benzothiazepines- diltiazem
a way to try and remember
(benz=lorazepam sounds like diltazem)

Question 20

what is the main difference b/t NonDHP and DHP?

Answer 20

Non-DHP-affect nodes (both verap and diltaz)

DHP-do not effect Nodes

Question 21

how do phenylalkylamines work?

Answer 21

Verapamil

binds to intracellular portion of alpha subunit 1

Question 22

how do benzothiazepines work

Answer 22

diltiazem

MOA not understood

Question 23

how do DHP work

Answer 23

modulate the L-type channel

vascular smooth muscle

Question 24

should someone be on cardizen and a BB?

Answer 24

no b/c they both affects nodes

Question 25

***************************** | can someone be on a BB and DHP CCB

Answer 25

sure the DHP CCB don't effect HR

Question 26

``` ******************************** out of the drugs Verapamil Non-DHP (phenylalkylamine) Diltiazem Non-DHP (benzothiazepine) Nifidipine DHP Nicardipine DHP which ones in order cause coronary vasodilation ```

Answer 26

Verapamil- moderate Diltiazem - mod Nifidipine - marked Nicardipine **** greatest

Question 27

``` ********************* out of the drugs Verapamil Non-DHP (phenylalkylamine) Diltiazem Non-DHP (benzothiazepine) Nifidipine DHP Nicardipine DHP whcih ones in order cause supression of cardiac contractility ```

Answer 27

Verapamil-moderate Diltiazem -mod Nifidipine - mod Nicardipine -0/slight

Question 28

``` ****************** out of the drugs Verapamil Non-DHP (phenylalkylamine) Diltiazem Non-DHP (benzothiazepine) Nifidipine DHP Nicardipine DHP which ones in order cause supression of SA node ```

Answer 28

Verapamil -mod Diltiazem - slight Nifidipine - none Nicardipine - none

Question 29

``` ************ out of the drugs Verapamil Non-DHP (phenylalkylamine) Diltiazem Non-DHP (benzothiazepine) Nifidipine DHP Nicardipine DHP which ones in order cause supression of AV node ```

Answer 29

Verapamil - marked Diltiazem - mod Nifidipine - none Nicardipine - none

Question 30

*********** | ex of DHP CCB

Answer 30

``` Nicardipine nifedipine nimodipine clevidipine amlodipine (-pine) (remember Ca++le graze in the -pine) ```

Question 31

pharmacology of Non-DHP

Answer 31

Neg inotropic Neg- chronotropic Neg-dromotropic positive- Lusitropic (myocardial relaxation)

Question 32

*********** | what do ALL CCB do pharmacology wise

Answer 32

- decrease coronary vascular resistance and increase coronary blood flow - Decrease PVR via vasodilation of arterioles - minimal venous tone effects

Question 33

************** which CCB is best for variant angia eg vasospastic or prinzmetal's angina

Answer 33

Narcardapine

Question 34

************ | which CCB is good for subarachnoid hemorrhage (posthemoragic cerebrovascular spasm

Answer 34

Nimodipine

Question 35

************* | which CCB's are good for Hypertrophic cardiomyopathy

Answer 35

Nifidipine | verapamil

Question 36

Common SE of CCB

Answer 36

-orthrostatic hypotension -bradycardiam(DHP increase HR) - periphreal edema - dizziness headaches flushing N/V

Question 37

Verapamil can increase the levels of what drug

Answer 37

Digoxin

Question 38

which CCB is commonly used in the OR Can be given bolus or infusion and what class

Answer 38

Nicardapine | DHP

Question 39

Which CCB is very fast onset off set, faster than nicardapine, prepared in a lipid emulsion, only given in bolus no infusion?

Answer 39

Clevidipine

Question 40

Contraindications to Verapimil

Answer 40

WPW Sicksinus syndrome Av block Heart rate

Question 41

**************** | how do CCB decrease contraction

Answer 41

decrease influx of Ca++ causes decrease in contraction

Question 42

************** basic way Non-DHP work

Answer 42

slow cardiac conduction | decrease HR via SA and AV nodes

Question 43

************** | basic way DHP work

Answer 43

no effect on conduction vasodilate increase HR

Question 44

*********** | what CCB is the greatest coronary vasodilator and can cause coronary steal?

Answer 44

Nicardapine

Question 45

Why are DHP and BB ok to use in combination

Answer 45

DHP incease HR and BB decrease HR

Question 46

************** | why do Non-DHP slow HR

Answer 46

closes the Ca++ channels in phase 4 thus decreasing hr | so it basically blocks the conduction and prolongs the time it takes to reah the threshold

Question 47

If HR is 45 and B/P is 210/105 what drug would you give

Answer 47

DHP like nicardapine or any | if has no effect on HR and will decrease BP