CCBs

Question 1

What are the two classes of CCBs?

Answer 1

Rate limiting CCBs (verapamil, diltiazem)
Dihydropyrodine CCBs (end in -dipine)

Question 2

CCBs with the exception of this drug must be avoided in HF as they can further depress cardiac function and exacerbate symptoms

Answer 2

amlodipine

Question 3

can verapamil be used with BB

Answer 3

NO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :)

Verapamil increases the risk of cardiovascular adverse effects when given with Acebutolol. Manufacturer advises use with caution or avoid.

Question 4

most common SE of verapamil

Answer 4

constipation . :(

Question 5

these 2 have a longer duration of action and can be given OD

Answer 5

amloďïpíņě
felodǐpįñë

Question 6

lacidipine and lercanidipine are licensed ONLY for

Answer 6

hypertension

Question 7

use diltiazem with caution in BB because

Answer 7

bradycardia risk

Question 8

true or false - all CCBs can increase mortality after MI in pt with LV dysfunction and pulmonary congesion

Answer 8

false exception is amlodipine

Question 9

SE associated with vasodilation for amlod, nifed, nircad, felodipine include

Answer 9

flushing and headache - less annoting after a few days
ankle swelling - may only partially respond to diuretics

Question 10

which one is highly negatively ionotropic

Answer 10

veramapil
it reduces CO, slows HR, can impair AV conduction
may precipitate HF, exacerbate conduction disorders and cause hypotension at high doses
do not use with BB

Question 11

Which type of CCB to give to patients?

Answer 11

• Depends on pt comorbidities & other drugs being taken
• Heart failure, avoid CCBs (except amlodipine, caution)
• Where possible prescribe a drug that is only taken OD
• Prescribe non-proprietary drugs where appropriate & minimise cost

Question 12

Which CCB may be preferred for people with hypertension ALONE, and why?

Answer 12

For people with hypertension alone, amlodipine may be preferred on the basis of cost

Question 13

Name some dihydropyriodine CCBs

Answer 13

• Amlodipine, felodipine, lacidipine, lercanidipine, nicardipine, nifedipine

Question 14

Name the rate limiting CCBs

Answer 14

• Verapamil, diltiazem

Question 15

In which situation would RL CCB be preferred to dihydropyridines?

Answer 15

In people with angina when beta-blocker is contraindicated or not tolerated

Question 16

Diltiazem - brand specifications

Answer 16

Different brands may not have the same clinical effect therefore prescribers need to specify the brand for MR preparations that are over 60mg

Question 17

Verapamil formulations

Answer 17

• OD formulations of verapamil recommended
• Non-proprietary verapamil needs to be taken BD
• MR verapamil preparations can be given OD, although higher doses are divided

Question 18

How often does non-proprietary verapamil need to be taken

Answer 18

BD dosing

Question 19

CCBs & heart failure

Answer 19

• All CCBs can precipitate heart failure in predisposed people
• DO NOT USE in patients with HF with reduced ejection fraction or history of significantly impaired LV function, even when controlled
• DO NOT USE RL CCBS in people with LV heart failure
• Although dihydropyridine’s rarely aggravate HF (any negative inotropic effect is offset by reduction in LV work), they should not be initiated in people with uncontrolled HF
• Amlodipine may be used WITH CAUTION in stable heart failure

Question 20

Which CCB may be used with caution in stable heart failure

Answer 20

Amlodipine

Question 21

Why should CCBs (except amlodipine) be avoided in heart failure

Answer 21

• Can further depress cardiac function & exacerbate symptoms
• Also increase mortality after MI in pt with LV dysfunction and pulmonary congestion

Question 22

CCBs & cardiac outflow obstruction

Answer 22

• E.g. significant aortic stenosis or obstructive hypertrophic cardiomyopathy
• Vasodilation may result in reduced cardiac output

Question 23

CCB & cardiogenic shock

Answer 23

CCBs contraindicated in pt with cardiogenic shock

Question 24

CCBs and diabetes mellitus

Answer 24

Diltiazem may increase BF - monitor carefully

Question 25

CCBs & AV block

Answer 25

Use with caution in 1st degree AV block
2nd or 3rd degree AV block - RL CCBs contraindicated

Question 26

CCBs and unstable angina or recent MI

Answer 26

Avoid within 1 month of MI

Question 27

CCBs and hepatic impairment

Answer 27

• Use with caution due to risk of increased exposure
• Dose adjustments and variation in medicinal form used may be required - see BNF for drug specific advice

Question 28

CCBs and renal impairment

Answer 28

Although diltiazem and verapamil are extensively metabolised in the lover, manufacturers recommend caution, dose reduction or monitoring in renal impairment

Question 29

CCBs & pregnancy/breastfeeding

Answer 29

Avoid, although some may be used as specific stages of pregnancy if benefit outweighs risk (see BNF)

Question 30

common SE

Answer 30

flushing
headache
ankle swelling
palpitations
tachycardia
abdominal pain
dizzy, drowsy

Question 31

treatment cessation and MI

Answer 31

some evidence that sudden withdrawal of CCB may be associated with exacerbation of MI!