HTN: CCB

Question 1

What are the DHP CCBs?

Answer 1

• Short acting: nifedipine**
• Longer acting: felodipine, isradipine, nicardipine, nisoldipine
• Long acting: Amlodipine**

Question 2

What are the non-DHP CCBs?

Answer 2

• Verapamil

- Diltiazem**

Question 3

DHP MOA

Answer 3

• Vasodilation by preferentially altering vascular smooth muscle–> dec PVR–> inc sympathetic tone–> blunts (-) ionotropic effect of DHP
• Little to no neg effect on cardiac contractility or conduction

Question 4

Non-DHP MOA

Answer 4

• Preferentially effects cardiac contractility and conduction–> neg ionotropic effect (verapamil > diltiazem)
• Less potent vasodilator

Question 5

Indications

Answer 5

• DHP: HTN, angina, Raynaud’s

- Non-DHP: Arrhythmias (SVT, a-fib), verapamil used for cluster HA prophy**

Question 6

Non-DHP Precautions/CI

Answer 6

• 2nd or 3rd degree AV block
• SSS (unless pacemaker)
• Brady <50 bpm
• HF
• B-blockers and digoxin (conduction issues)**
• Anti-HTN and vasodilators (DHP and non-DHP)

Question 7

3A4 substrates

Answer 7

• Nifedipine, amlodipine, diltiazem

- Clarithro-amlodipine ass w hypoTN, edema, brady, AKI

Question 8

3A4 inhibitors

Answer 8

Non-DHP CCB (verapamil/diltiazem)

Question 9

DHP ADRs

Answer 9

• Less likely w long acting agents
• HA, dizziness, flushing
• Peripheral edema, reflex tachy**
• Dyspepsia
• Special ADR: gingival hyperplasia (nifedipine >amlodipine)

Question 10

Non-DHP ADRs

Answer 10

• HA, dizziness, flushing, peripheral edema

- Special: verapamil (constipation)**

Question 11

CCB general MOA

Answer 11

Inhibit L-type Ca channel