CCBs Flashcards
1
Q
what are the 3 chemical structures of CCBs (P,D,B)
A
phenylalkylamines, dihydropyridines, benzothiazepines
2
Q
what are the 4 common SEs of CCBS (SH, PE, F, H)
A
systemic hypotension, peripheral edema, flushing, headache
3
Q
what 2 CCB classes are selective for the AV node?
A
phenylalkylamines, benzothiazepines
4
Q
which CCB class is selective for the arteriolar beds?
A
dihydropyridines
5
Q
which CCB is a phenylalkylamine?
A
verapamil
6
Q
which CCB is a benzothiazepine?
A
diltiazem
7
Q
what are the 5 dihydropyridines? (F,A,N,N,N)
A
felodipine, amlodipine, nicardipine, nimodipine, nifedipine
8
Q
Non-dihydropyridines work at what 2 areas of the heart that the dihydropyridines don’t?
A
SA node, AV node
9
Q
what is a first generation dihydropyridine?
A
nifedipine
10
Q
what is a second generation dihydropyridine?
A
nicardipine
11
Q
what is a third generation dihydropyridine?
A
amlodipine
12
Q
what CCB has the greatest coronary artery dilation?
A
nicardipine
13
Q
does verapamil or diltiazem depress the SA and AV nodes more?
A
verapamil
14
Q
what are the three types of calcium channels?
A
L, N, T
15
Q
what calcium channels do vascular and cardiac SM contain?
A
L-type, T-type
16
Q
what calcium channel do nerves contain?
A
N-type
17
Q
what are the 5 subunits on the L type Ca channel?
A
alpha1, alpha2, beta, gamma, delta
18
Q
what L-type channel subunit provides the central part of the channel and the main path for Ca entry?
A
alpha1
19
Q
all CCBs bind to what subunit to diminish entry of Ca ions into cells?
A
alpha 1
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
21
Q
Cytoplasmic Ca concentration plays an important role in the degree of tension where? (VSM)
A
vascular smooth muscle
22
Q
by blocking L-type Ca channels and diminishing the concentration of cytoplasmic Ca, vascular SM does what? (R)
A
relaxes
23
Q
cardiac contractility is dependent on the influx of what into cardiac cells?
A
calcium
24
Q
ca binds to what protein?
A
troponin
25
by binding to troponin, ca allows what 2 proteins to interact?
actin, myosin
26
the greater degree of actin and myosin interaction, the greater degree of what? (CC)
cardiac contraction
27
by decreasing myocardial force generation and contraction, what negative effect is this?
negative inotropy
28
what 2 phases do CCBs work on nodal AP?
phase 4 and 0
29
what phase do CCBs work on myocytes?
phase 2
30
by blocking phase 4 of nodal cells, CCBs are slowing down the nodal cells ability to get where?
thershold
31
what is happening in phase 4 of the nodal cells that CCBs are slowing? (SSD)
slow spontaneous depolarization
32
what is happening in phase 0 of the nodals cells that CCBs are slowing?
depolarization
33
AKA for phase 2 of myocyte cells?
plateau phase
34
by extending phase 2 of myocyte cells, what are CCBs prolonging?
ERP
35
since CCBs slow the conduction thru the AV node and decreasing the HR, so them has what negative effect?
chronotropy
36
CCBs decrease conduction velocity in the heart thru the AV node causing them to have what negative effect?
dromotropy
37
Because CCBs slow the conduction thru the AV node, they are work well against what type of rhythms?
SVTs
38
phenylalkylamines bind to what portion of the alpha 1 subunit when the ca channel is in what state?
intracellular portion, open
39
phenylalkylamines bind to the intracellular portion of the alpha 1 subunit and do what to the channel? (O)
occlude it
40
what part of verapamil's racemic mixture binds to L type Ca channels?
levoisomer
41
what part of verapamil's racemic mixture binds to fast sodium channels?
dextroisomer
42
Verapamil is contraindicated for what 4 pts? (HF, SB, SND, AVNB)
heart failure, severe bradycardia, sinus node dysfunction, AV nodal block
43
what are 6 clinical uses of verapamil? (SVTDs, VAP, SH, SHC, M/F TD, PL)
supraventricular tachydysrythmias, vasospastic angina pectoris, systemic HTN, symptomatic hypertrophic cardiomyopathy, maternal/fetal tachydysrhythmias, premature labor
44
what CCB will neuro IR inject directly into spasming cerebral artery?
verapamil
45
how do dihydropyridines prevent ca entry into vascular SM cells of the L-type VG Ca channel? (ECAM)
extra cellular allosteric moduclation
46
what vessels do nifedipine, nicardipine, felodipine and amlodipine favor action?
peripheral arterioles
47
what vessels does nimodipine favor action?
cerebral vessels
48
in one word describe dihydropyridines venous vasodilating effects? (M)
minimal
49
what reflex can be seen with acute administration of dihydropyridines?
reflex tachycardia
50
reflex tachycardia seen with acute administration of dihydropyridines is attributed to what system or what reflexes?
SNS, baroreceptor reflexes
51
what 3 direct negative effects of nifedipine does the SNS counter?
inotropic, chronotropic, dromotropic
52
nifedipine is contraindicated for what pt?
acute MI
53
nifedipine is used to treat pt's with systemic HTN and angina pectoris d/t what? (CAV)
coronary artery vasospasm
54
careful giving nifedipine to what 2 pt conditions and with what other med? (LVD, AS; BB)
LV dysfunction, aortic stenosis; beta blockers
55
what are 5 SEs of nifedipine? (F, V, H, PE, RD)
flushing, vertigo, HA, peripheral edema, renal dysfunction
56
abrupt discontinuation of nifedipine can cause what? (CAV)
coronary artery vasospasm
57
which CCB has the greatest vasodilating effects?
Nicardipine
58
combo of Nicardipine with what other drug class is used to treat angina?
beta blockers
59
what CCB is used as a tocolytic drug (suppressing premature labor) by biding to myometrial Ca channels?
Nicardipine
60
Nicardipine is used a lot for strict BP control of what neuro cases? (AC/C)
aneurysm clip/coiling
61
Nicardipine is used for controlled hypotension for what procedures and what surgeries? (CFP, LSS)
craniofacial procedures, large spinal surgeries
62
what other surgery cases is Nicardipine used for? (VC)
vascular cases
63
nimodipine is highly what facilitating its entrance into the CNS?
lipid soluble
64
nimodipine enter the CNS and blocks the influx of Ca into what arteries?
vertebral
65
nimodipine's ability to cross the BBB allows it to treat pt's with what?
SAH
66
nimodipine prevents what from happening to cerebral arteries in pts with SAH?
cerebral vasospasm
67
what CCB provides antiischemic effects comparable to beta blockers in pts with acute coronary syndrome?
amlodipine
68
the combination of what CCB and what other drug class may be more effective in treating myocardial ischemia than either drug alone?
amlodipine and beta blockers
69
diltiazem works on what L-type channel subunit, but the MOA is not well understood?
alpha 1
70
since diltiazem predominately blocks AV node Ca channels, it is a first line treatment for what tachydysrhythmias?
supraventricular
71
diltiazem may also be used for chronic control of what? (EH)
essential hypertension
72
since diltiazem exerts minimal cardiodepressant effects, it is unlikely to interact with what class of med?
beta blockers
73
CCBs must be administered with caution in what 2 pts, particularly if these pts are getting CCBs in combination with what? (LVD, H; V)
LV dysfunction, hypovolemia, VA
74
why must CCBs be given with caution to pt's getting VA?
VA block Ca channels and are potent vasodilators
75
do CCBs potentiate the effects of depolarizing NMBs, nondepolarizing NMBs, or both?
both
76
verapamil has a higher tendency for complete AV block so caution must be used to pts taking what 2 med types? (D, BB)
digitalis, beta blockers
77
what 2 CCBs have potent LA activity that may increase the risk of LAST?
verapamil, diltiazem
78
CCBs may slow the inward movement of what ion causing what?
potassium, hyperkalemia
79
what lab abnormality can occur in pts receiving verapamil and exogenous K/stored whole blood?
hyperkalemia
80
Can pts taking CCBs take them on day of surgery?
yes
81
administration of dantrolene in the presence of verapamil or diltiazem results in what 2 things? (H, CVC)
hyperkalemia, CV collapse
82
administration of dantrolene in the presence of verapamil requires what type of monitoring and continuous measurements of what ion?
invasive hemodynamic monitoring, potassium
83
CCBs may increase the concentration of what drug by decreasing its plasma clearance?
digoxin
84
what 2 H2 blockers may increase the plasma concentrations of CCBs by altering hepatic enzymes and/or hepatic BF? (C, R)
cimetidine, ranitidine
85
CCBs may interfere with the ca-mediated function of what component of the blood?
plts
86
pts receiving chronic dihydropyridine have an increased chance of what during the periop period?
bleeding
87
pts receiving chronic dihydropyridine have an increased bleeding in what body system?
GI
88
pts receiving chronic CCBs may have an increased risk of developing what compared to chronic treatment with beta blockers or ACE inhibitors?
cancer
89
because of the chronic risk factors, CCBs should be reserved for what step of treatment?
second step rather than inital therapy
90
CCBs may provide cytoprotection against what injury? (IRI)
ischemic reperfusion injury
91
CCBs may protect against ischemic reperfusion injury by decreasing Ca entry into cells and thus limiting the accumulation of what?
oxygen free radicals
92
CCBs may attenuate renal injury from nephrotoxic drugs by increasing what 2 things?
renal BF, GFR
