CCB (Stable Angina CAD Flashcards
Dihydropyridines:
–Nifedipine
–Amlodipine
–Felodipine (the pines)
(selective vasodilators with minimal AV node activity)
Non Dihydropyridines:
–Verapamil
–Diltiazem
(ALT to BB) rate control, antianginal, lower BP thru depressed AV node, coronary and arterial vessel dilation
MOA CCB
**All CCBs are arterial vasodilators
similar BP reduction and hemodynamics, but diff tolerability
inhibits Ca mediated depolarization— = muscle relaxation!
Dihydro indications
better then V&D for most pts who need anginal mgmt
-vascular smooth muscle depends on Ca for restin tone and for contractile responses
Non Dihydro indications
IV forms for acute HR and BP control
-for vasospastic angina (increase in combo with nitrates)
-V>D for cardiac conduction/output
-Verapamil & diltiazem: lower myocardial O2 demand
By lowering HR, contractility, PVR, ischemic time, BP, workload
slower rate improves venous perfusion and ventricular filling
CCB SE
CCB toxicity
Cardiac arrest, CV collapse, HF, AV block, Bradycardia, edema
Contribute to toxicity of other drugs (additive effects on hemodynamics and DI)
Verapamil and diltiazem MOA
prevents influx of Ca in SA, AV, myocardium smooth muscle
↓Cardiac work and MVO2 by ↓SA, AV automaticity, HR, vasospasm, coronary vascular resistance, SVR, LV inotropy
Indications of Verapamil
For SA, AV conduction and CO verapamil > diltiazem
Metabolism and DI of verapamil
Dose adjust to BP, HR, exercise tolerance
Potent CYP3A4 inhibitor resulting in simultaneous CYP3A4 and PGP efflux pump DI:
Statins, atypical antipsychotics, antiarrhythmics, digoxin, azoles, warfarin, CBZ, CYA, macrolides
Contraindications Of Verapamil and Diltiazem
avoided in HF pts
can use with pacer
SE of Verapamil
20% gingival hyperplasia
12% constipation
Considerations of Verapamil and Diltiazem
Hard for pts with low EF to tolerate
Diltiazem indications
*tolerated better then ^verapamil
Diltiazem metabolism
Dose adjust to BP, HR, exercise tolerance
Strong CYP3A4 substrate-interferes with met of other CYP3A4 substrates: antiarrhymics, statins, azoles, digoxin, atypicals, warfarin, CBZ, CYA, macrolides
Diltiazem SE
Peripheral edema in 2-3 weeks in 15-33% of pts
H/A in 12%
AV block 10%
Nifedipine + Bepridil MOA
Relaxes coronary and peripheral smooth muscle, reduces vasospasm, reduces resistance and afterload to reduce MVO2 needs
Nifedipine indications
For vasospastic angina control and to lower bp (XL, SR preferred)
Raynauds Phenomenon
Can be used carefully with BBlockers
Nifedipine metabolism
Extensive protein binding (92-98%) High bioavailability (77-90%)
Half life 2-5 hrs, 7 hrs in elderly and liver dz
Nifedipine CI
**CI SL or oral nifedipiine HTN emergencies bc it will rebound sympathetic activity and CV mortality in CAD pts
Nifedipine SE
Peripheral edema in 30%
Flushing, h/a, orthostasis in 25%
Nifedipine considerations
XL casing passes undigested in stool
MOA:
Nicardipine
Amlodipine
Felodipine
Relaxes coronary and peripheral smooth muscle
Reduces resistance and afterload to reduce MVO2 needs
No effects on HR
Indications of
Nicardipine
Amlodipine
Felodipine
Can be used carefully with BBlockers
Amlodipine indications
Can be used carefully with BBlockers
Long acting alternate to nifedipine XL
