CCBs

Question 1

Examples of Dihydropyridine CCBs and MOA

Answer 1

MOA: act predominantly on Ca Channels of the arteries and cause vasodilation. No effect on HR or Inotropy,

• Amlodipine
• Felodipine
• Isradipine
• Nifedipine

ALL THAT END IN -IDINE

These may cause reflex tachycardia related to the Barrow Receptors’ response to vasodilation. BR relfex activation of sympathetic nerves and lack of direct negative cardiac effects can make them a less desirable choice for stable angina then BB or NON DI’s

Question 2

Examples of Non-Dihydropyridine CCBs

Answer 2

*** Reduces Ventricular Response. Better for angina and some types of arrhythmias

• Diltiazem
• Verapamil

DI-VER

Question 3

Similarity in BB and CCB

Answer 3

Same action on the heart

Both Reduce Force of Contraction
Reduce Heart Rate
Suppress Conduction through the AV Node

Question 4

Indications for Dihydropyridine CCBs

Answer 4

Hypertension
+
Raynaud’s Disease (Decreases arterial vasospasm)

Question 5

Indications for Non-Dihydropyridine CCBs ***

Answer 5

Control stable and unstable angina
+
Dysrhythmias

Question 6

CCB Adverse Effects

Answer 6

Vasodilating effects such as dizziness, flushing, headache, weakness, PERIPHERAL EDEMA

Fatigue (so take at night)
Constipation
Eczematous Rash - esp in elderly

With Non DIHY’s *****
- caution with bradycardia, sick sinus syndrome, heart failure or second degree, third degree AV block

Note: HF caused by systolic dysfunction should not be given CCB

Question 7

CCB Drug Interactions *** look up

Answer 7

CYP3A4 Inhibitors

• Azoles, cimetidine and many others
• Grapefruit juice
• Digoxin (increase effect from non DIHYs)

Additive Effects with BB