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pharm > chapter 45: calcium channel blockers > Flashcards

chapter 45: calcium channel blockers Flashcards

1
Q

what are three overall therapeutic uses of calcium channel blockers

A

hypertension, angina pectoris and cardiac dysrhythmias

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2
Q

what do calcium channel blockers have the greatest effect on

A

heart and vascular smooth muscle

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3
Q

what are calcium channels

A

gated pores in cytoplasmic membrane that regulate entry of calcium into cells

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4
Q

what do calcium channels regulate in the VSM

A

contraction

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5
Q

what do calcium channels act on in the VSM

A

peripheral arterioles and arterioles in the heart

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6
Q

action potential causes calcium channels to do what

A

calcium channels open and ions move inward which causes contraction

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7
Q

what do calcium channels do in the heart

A

helps regulate function of the myocardium, SA and AV

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8
Q

what are calcium channels coupled to

A

beta1 adrenergic receptors

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9
Q

what happens if calcium channels are blocked

A

relaxation

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10
Q

what do calcium channel blockers do to inotropic effect, force of contractility, heart rate and dromotopic effect?

A

all are decreased

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11
Q

what type of chronotropic effect does calcium have?

A

positive

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12
Q

what type of inotropic effect does calcium have?

A

positive

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13
Q

what type of dromotropic effect does calcium have?

A

positive

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14
Q

what CCB works on arterioles at therapeutic doses?

A

nefedipine

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15
Q

if nifedipine dose becomes toxic, what effects could it produce?

A

significant cardiac suppression

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16
Q

what could nifedipine help with

A

coronary perfusion

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17
Q

what effect does nifedipine have on heart rate and force of contractility?

A

normally does not effect these two in any way

18
Q

what CCBs work on arterioles and the heart?

A

verapamil and diltiazem

19
Q

what is an indirect effect seen with verapamil and diltiazem

A

reflex tachycardia

20
Q

what are the three net effects seen with verapamil and diltiazem?

A

vasodilation, reduced arterial pressure, increased coronary perfusion

21
Q

where does blockade occur with verapamil and diltiazem?

A

peripheral arterioles that result in dilation, arteries and arterioles in heart, SA node, AV node, myocardium

22
Q

what does blockade on peripheral arterioles lead to?

A

decreased arterial pressure and decreased vascular resistance

23
Q

blockade on arteries and arterioles in heart has what effect?

A

improving coronary perfusion

24
Q

blockade in SA and AV node has what two effects?

A

decreased heart rate and decreased AV impulses

25
Q

the blockade on myocardium of the heart produces what effect?

A

decreased contractility

26
Q

a patient comes into the clinic complaining of constipation and headache. during your assessment you notice flushing and slight edema in their ankles. what CCB do you suspect they may be taking?

A

verapamil or diltiazem

27
Q

what are the effects that verapamil/diltiazem can have on the heart

A

symptomatic bradycardia (SA node blocked), partial or complete AV block or decreased contractility (myocardium blocked)

28
Q

what drug should you not use a BB with?

A

verapamil/diltiazem

29
Q

what are 3 drug-drug interactions with verapamil/diltiazem?

A

digoxin, beta-adrenergic blockers, grapefruit juice

30
Q

what can concurrent use of verapamil and metaprolol cause?

A

massive cardiac suppressions

31
Q

what are the therapeutic uses for nifedipine

A

hypertension and angina pectoris

32
Q

what can nifedipine NOT be used for?

A

cardiac dysrhythmias

33
Q

where are nifedipine direct effects located?

A

VSM

34
Q

what does nifedipine help increase?

A

force of contractility

35
Q

what drug can nifedipine be given concurrently with?

A

beta-adrenergic blocker

36
Q

nifedipine has no opposition for what?

A

reflex tachycardia

37
Q

what formulation of nifedipine safer to use?

A

sustained release rather than immediate release

38
Q

a rapid decrease in BP with nifedipine can cause what?

A

will stimulate the baroreceptor reflex which can cause reflex tachycardia

39
Q

what are the direct effects experienced with nifedipine

A

peripheral vasodilation and increased coronary perfusion

40
Q

what is the one ADR seen with verapamil that is NOT seen with nifedipine?

A

constipation

41
Q

what is a positive drug interaction with nifedipine

A

beta-adrenergic blockers

42
Q

what is nifedipine the preferred drug for?

A

AV heart block, heart failure, or bradycardia

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