CCBs Flashcards
What are the two classes of CCBs?
Rate limiting CCBs (verapamil, diltiazem)
Dihydropyrodine CCBs (end in -dipine)
CCBs with the exception of this drug must be avoided in HF as they can further depress cardiac function and exacerbate symptoms
amlodipine
can verapamil be used with BB
NO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :)
Verapamil increases the risk of cardiovascular adverse effects when given with Acebutolol. Manufacturer advises use with caution or avoid.
most common SE of verapamil
constipation . :(
these 2 have a longer duration of action and can be given OD
amloďïpíņě
felodǐpįñë
lacidipine and lercanidipine are licensed ONLY for
hypertension
use diltiazem with caution in BB because
bradycardia risk
true or false - all CCBs can increase mortality after MI in pt with LV dysfunction and pulmonary congesion
false exception is amlodipine
SE associated with vasodilation for amlod, nifed, nircad, felodipine include
flushing and headache - less annoting after a few days
ankle swelling - may only partially respond to diuretics
which one is highly negatively ionotropic
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
Which type of CCB to give to patients?
- 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
Which CCB may be preferred for people with hypertension ALONE, and why?
For people with hypertension alone, amlodipine may be preferred on the basis of cost
Name some dihydropyriodine CCBs
- Amlodipine, felodipine, lacidipine, lercanidipine, nicardipine, nifedipine
Name the rate limiting CCBs
- Verapamil, diltiazem
In which situation would RL CCB be preferred to dihydropyridines?
In people with angina when beta-blocker is contraindicated or not tolerated
Diltiazem - brand specifications
Different brands may not have the same clinical effect therefore prescribers need to specify the brand for MR preparations that are over 60mg
Verapamil formulations
- 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
How often does non-proprietary verapamil need to be taken
BD dosing
CCBs & heart failure
- 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
Which CCB may be used with caution in stable heart failure
Amlodipine
Why should CCBs (except amlodipine) be avoided in heart failure
- Can further depress cardiac function & exacerbate symptoms
- Also increase mortality after MI in pt with LV dysfunction and pulmonary congestion
CCBs & cardiac outflow obstruction
- E.g. significant aortic stenosis or obstructive hypertrophic cardiomyopathy
- Vasodilation may result in reduced cardiac output
CCB & cardiogenic shock
CCBs contraindicated in pt with cardiogenic shock
CCBs and diabetes mellitus
Diltiazem may increase BF - monitor carefully
