CCBs Flashcards

1
Q

what are the 3 chemical structures of CCBs (P,D,B)

A

phenylalkylamines, dihydropyridines, benzothiazepines

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2
Q

what are the 4 common SEs of CCBS (SH, PE, F, H)

A

systemic hypotension, peripheral edema, flushing, headache

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3
Q

what 2 CCB classes are selective for the AV node?

A

phenylalkylamines, benzothiazepines

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4
Q

which CCB class is selective for the arteriolar beds?

A

dihydropyridines

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5
Q

which CCB is a phenylalkylamine?

A

verapamil

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6
Q

which CCB is a benzothiazepine?

A

diltiazem

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7
Q

what are the 5 dihydropyridines? (F,A,N,N,N)

A

felodipine, amlodipine, nicardipine, nimodipine, nifedipine

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8
Q

Non-dihydropyridines work at what 2 areas of the heart that the dihydropyridines don’t?

A

SA node, AV node

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9
Q

what is a first generation dihydropyridine?

A

nifedipine

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10
Q

what is a second generation dihydropyridine?

A

nicardipine

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11
Q

what is a third generation dihydropyridine?

A

amlodipine

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12
Q

what CCB has the greatest coronary artery dilation?

A

nicardipine

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13
Q

does verapamil or diltiazem depress the SA and AV nodes more?

A

verapamil

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14
Q

what are the three types of calcium channels?

A

L, N, T

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15
Q

what calcium channels do vascular and cardiac SM contain?

A

L-type, T-type

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16
Q

what calcium channel do nerves contain?

A

N-type

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17
Q

what are the 5 subunits on the L type Ca channel?

A

alpha1, alpha2, beta, gamma, delta

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18
Q

what L-type channel subunit provides the central part of the channel and the main path for Ca entry?

A

alpha1

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19
Q

all CCBs bind to what subunit to diminish entry of Ca ions into cells?

A

alpha 1

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20
Q

CCBs bind to L-type Ca channels in what 3 ares? (VSM, CM, CNT)

A

vascular smooth muslce, cardiac myocytes, cardiac nodal tissue

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21
Q

Cytoplasmic Ca concentration plays an important role in the degree of tension where? (VSM)

A

vascular smooth muscle

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22
Q

by blocking L-type Ca channels and diminishing the concentration of cytoplasmic Ca, vascular SM does what? (R)

A

relaxes

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23
Q

cardiac contractility is dependent on the influx of what into cardiac cells?

A

calcium

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24
Q

ca binds to what protein?

A

troponin

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25
Q

by binding to troponin, ca allows what 2 proteins to interact?

A

actin, myosin

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26
Q

the greater degree of actin and myosin interaction, the greater degree of what? (CC)

A

cardiac contraction

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27
Q

by decreasing myocardial force generation and contraction, what negative effect is this?

A

negative inotropy

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28
Q

what 2 phases do CCBs work on nodal AP?

A

phase 4 and 0

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29
Q

what phase do CCBs work on myocytes?

A

phase 2

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30
Q

by blocking phase 4 of nodal cells, CCBs are slowing down the nodal cells ability to get where?

A

thershold

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31
Q

what is happening in phase 4 of the nodal cells that CCBs are slowing? (SSD)

A

slow spontaneous depolarization

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32
Q

what is happening in phase 0 of the nodals cells that CCBs are slowing?

A

depolarization

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33
Q

AKA for phase 2 of myocyte cells?

A

plateau phase

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34
Q

by extending phase 2 of myocyte cells, what are CCBs prolonging?

A

ERP

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35
Q

since CCBs slow the conduction thru the AV node and decreasing the HR, so them has what negative effect?

A

chronotropy

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36
Q

CCBs decrease conduction velocity in the heart thru the AV node causing them to have what negative effect?

A

dromotropy

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37
Q

Because CCBs slow the conduction thru the AV node, they are work well against what type of rhythms?

A

SVTs

38
Q

phenylalkylamines bind to what portion of the alpha 1 subunit when the ca channel is in what state?

A

intracellular portion, open

39
Q

phenylalkylamines bind to the intracellular portion of the alpha 1 subunit and do what to the channel? (O)

A

occlude it

40
Q

what part of verapamil’s racemic mixture binds to L type Ca channels?

A

levoisomer

41
Q

what part of verapamil’s racemic mixture binds to fast sodium channels?

A

dextroisomer

42
Q

Verapamil is contraindicated for what 4 pts? (HF, SB, SND, AVNB)

A

heart failure, severe bradycardia, sinus node dysfunction, AV nodal block

43
Q

what are 6 clinical uses of verapamil? (SVTDs, VAP, SH, SHC, M/F TD, PL)

A

supraventricular tachydysrythmias, vasospastic angina pectoris, systemic HTN, symptomatic hypertrophic cardiomyopathy, maternal/fetal tachydysrhythmias, premature labor

44
Q

what CCB will neuro IR inject directly into spasming cerebral artery?

A

verapamil

45
Q

how do dihydropyridines prevent ca entry into vascular SM cells of the L-type VG Ca channel? (ECAM)

A

extra cellular allosteric moduclation

46
Q

what vessels do nifedipine, nicardipine, felodipine and amlodipine favor action?

A

peripheral arterioles

47
Q

what vessels does nimodipine favor action?

A

cerebral vessels

48
Q

in one word describe dihydropyridines venous vasodilating effects? (M)

A

minimal

49
Q

what reflex can be seen with acute administration of dihydropyridines?

A

reflex tachycardia

50
Q

reflex tachycardia seen with acute administration of dihydropyridines is attributed to what system or what reflexes?

A

SNS, baroreceptor reflexes

51
Q

what 3 direct negative effects of nifedipine does the SNS counter?

A

inotropic, chronotropic, dromotropic

52
Q

nifedipine is contraindicated for what pt?

A

acute MI

53
Q

nifedipine is used to treat pt’s with systemic HTN and angina pectoris d/t what? (CAV)

A

coronary artery vasospasm

54
Q

careful giving nifedipine to what 2 pt conditions and with what other med? (LVD, AS; BB)

A

LV dysfunction, aortic stenosis; beta blockers

55
Q

what are 5 SEs of nifedipine? (F, V, H, PE, RD)

A

flushing, vertigo, HA, peripheral edema, renal dysfunction

56
Q

abrupt discontinuation of nifedipine can cause what? (CAV)

A

coronary artery vasospasm

57
Q

which CCB has the greatest vasodilating effects?

A

Nicardipine

58
Q

combo of Nicardipine with what other drug class is used to treat angina?

A

beta blockers

59
Q

what CCB is used as a tocolytic drug (suppressing premature labor) by biding to myometrial Ca channels?

A

Nicardipine

60
Q

Nicardipine is used a lot for strict BP control of what neuro cases? (AC/C)

A

aneurysm clip/coiling

61
Q

Nicardipine is used for controlled hypotension for what procedures and what surgeries? (CFP, LSS)

A

craniofacial procedures, large spinal surgeries

62
Q

what other surgery cases is Nicardipine used for? (VC)

A

vascular cases

63
Q

nimodipine is highly what facilitating its entrance into the CNS?

A

lipid soluble

64
Q

nimodipine enter the CNS and blocks the influx of Ca into what arteries?

A

vertebral

65
Q

nimodipine’s ability to cross the BBB allows it to treat pt’s with what?

A

SAH

66
Q

nimodipine prevents what from happening to cerebral arteries in pts with SAH?

A

cerebral vasospasm

67
Q

what CCB provides antiischemic effects comparable to beta blockers in pts with acute coronary syndrome?

A

amlodipine

68
Q

the combination of what CCB and what other drug class may be more effective in treating myocardial ischemia than either drug alone?

A

amlodipine and beta blockers

69
Q

diltiazem works on what L-type channel subunit, but the MOA is not well understood?

A

alpha 1

70
Q

since diltiazem predominately blocks AV node Ca channels, it is a first line treatment for what tachydysrhythmias?

A

supraventricular

71
Q

diltiazem may also be used for chronic control of what? (EH)

A

essential hypertension

72
Q

since diltiazem exerts minimal cardiodepressant effects, it is unlikely to interact with what class of med?

A

beta blockers

73
Q

CCBs must be administered with caution in what 2 pts, particularly if these pts are getting CCBs in combination with what? (LVD, H; V)

A

LV dysfunction, hypovolemia, VA

74
Q

why must CCBs be given with caution to pt’s getting VA?

A

VA block Ca channels and are potent vasodilators

75
Q

do CCBs potentiate the effects of depolarizing NMBs, nondepolarizing NMBs, or both?

A

both

76
Q

verapamil has a higher tendency for complete AV block so caution must be used to pts taking what 2 med types? (D, BB)

A

digitalis, beta blockers

77
Q

what 2 CCBs have potent LA activity that may increase the risk of LAST?

A

verapamil, diltiazem

78
Q

CCBs may slow the inward movement of what ion causing what?

A

potassium, hyperkalemia

79
Q

what lab abnormality can occur in pts receiving verapamil and exogenous K/stored whole blood?

A

hyperkalemia

80
Q

Can pts taking CCBs take them on day of surgery?

A

yes

81
Q

administration of dantrolene in the presence of verapamil or diltiazem results in what 2 things? (H, CVC)

A

hyperkalemia, CV collapse

82
Q

administration of dantrolene in the presence of verapamil requires what type of monitoring and continuous measurements of what ion?

A

invasive hemodynamic monitoring, potassium

83
Q

CCBs may increase the concentration of what drug by decreasing its plasma clearance?

A

digoxin

84
Q

what 2 H2 blockers may increase the plasma concentrations of CCBs by altering hepatic enzymes and/or hepatic BF? (C, R)

A

cimetidine, ranitidine

85
Q

CCBs may interfere with the ca-mediated function of what component of the blood?

A

plts

86
Q

pts receiving chronic dihydropyridine have an increased chance of what during the periop period?

A

bleeding

87
Q

pts receiving chronic dihydropyridine have an increased bleeding in what body system?

A

GI

88
Q

pts receiving chronic CCBs may have an increased risk of developing what compared to chronic treatment with beta blockers or ACE inhibitors?

A

cancer

89
Q

because of the chronic risk factors, CCBs should be reserved for what step of treatment?

A

second step rather than inital therapy

90
Q

CCBs may provide cytoprotection against what injury? (IRI)

A

ischemic reperfusion injury

91
Q

CCBs may protect against ischemic reperfusion injury by decreasing Ca entry into cells and thus limiting the accumulation of what?

A

oxygen free radicals

92
Q

CCBs may attenuate renal injury from nephrotoxic drugs by increasing what 2 things?

A

renal BF, GFR