CCBs

Question 1

How do CCBs work?

Answer 1

They inhibit calcium entry into contractile cells

Question 2

How are CCB’s metabolized?

Answer 2

Hepatically (well absorbed)

Question 3

What is the effect of vascular specific CCB’s?

Answer 3

Relaxation of arteriolar smooth muscle causing decreased TPR

Question 4

How do cardiac specific CCB’s work?

Answer 4

Decrease cardiac contractility and conduction

-inotropy and -chrontropy

Question 5

What is the oldest calcium channel blocker in use and what is its mechanism?

Answer 5

Verapamil – inhibits entry of calcium ions through to slow channels, prolonging AV node conduction (95% effect on the heart, 5% effect on vasculature)

Question 6

Which patients should avoid verapamil?

Answer 6

Patients with CHF or bradycardia

Question 7

List 4 adverse reactions to verapamil

Answer 7

Hypotension, CHF, peripheral edema, constipation

Question 8

What three conditions can be managed with a calcium channel blocker?

Answer 8

Angina, selected arrhythmias, and hypertension

Question 9

What is the usual dose of verapamil? List alternatives

Answer 9

Immediate release 80 to 120 mg PO TID

Also comes in: IV, circadian dosing (taken at HS, $$$) or standard release (taken with food)

Question 10

What should be monitored while patient takes verapamil?

Answer 10

Blood pressure, heart rate, EKG (PR prolongation)

Question 11

Which CCB is equally specific for vasculature and myocardium?

Answer 11

Diltiazem

Question 12

Which form of Diltiazem (injectable or oral) is usually used to treat a fib?

Answer 12

Injectable

Question 13

List the adverse effects of Diltiazem

Answer 13

Bradycardia, peripheral edema, flushing, rare AV block

Question 14

How is diltiazem dosed?

Answer 14

Start with IR 30 mg PO QID, gradually increased dose over 1-2 days until desired response is achieved (max 240 to 360 mg per day)

Question 15

What is Cardizem CD?

Answer 15

A continuous dose of Diltiazem taken only once per day (180-240mg capsules)

Question 16

How should Cardizem (Diltiazem) standard release products be taken?

Answer 16

Take in a.m. and do not chew or crush

Question 17

Who should avoid or be extremely cautious in taking Diltiazem?

Answer 17

CHF patients, heart block patients, patients on beta blockers

Question 18

Where are the major effects of nifedipine seen?

Answer 18

95% on vasculature, 5% on myocardium

Question 19

What are adverse affects of nifedipine?

Answer 19

Flushing, rash, peripheral edema, dizziness, gingival hyperplasia

Question 20

List alternative uses for nifedipine

Answer 20

Migraine prophylaxis, achalasia, Raynauds

Question 21

Where does amlodipine have most of its effect?

Answer 21

99% on vasculature (very safe for CHF patients)

Question 22

How often is amlodipine taken?

Answer 22

Only once a day (max dose to 10 mg)

Question 23

Describe the difference between quality of peripheral edema as side effects of amlodipine and nifedipine, verapamil and diltiazem

Answer 23

Amlodipine and nifedipine – noncardiogenic peripheral edema

Diltiazem and verapamil – cardiogenic peripheral edema

Question 24

What letters do all dihydropyridine drugs end in?

Answer 24

“dipine”