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CH 45

Calcium Channel Blockers

CCB have their greatest effects on: the heart and blood vessels
What are CCBs used to treat? - hypertension - Angina pectoris - cardiac dysrhythmias
Critical Role that CCB play? - function of vascular smooth muscle (VSM)
CCBS act selectively on? - peripheral arterioles and arteries - no effect on veins
Nifedipine - works on arterioles
verapamil & diltiazem - works on arterioles AND heart
Verapamil - blocks ca channel in blood vessels and in the hearts
Verapamil uses: - angina (widely used) - essential hypertension (2nd line agent after Thiazide diuretics) - cardiac dysrhythmias (given IV)
5 direct effects of Verapamil: 1. Decrease of AV nodal conduction (most important**) 2. blockade at peripheral arterioles causing dilation and reducing arterial pressure 3. Block at arterioles and arteries of heart to increase coronary perfusion 4 & 5
Indirect (reflex) effect of Verapamil - lowers blood pressure which activates baroreceptor reflex
Does Verapamil have net effect on the heart? NO
Verapamil administration - given orally or IV
Verapamil ADVERSE EFFECTS - CONSTIPATION ** Most common - bradycardia - Gingival hyperplasia - Chronic eczematous rash
Verapamil food and drug interactions - Digoxin - Beta Blockers - Grapefruit Juice
What is used to remove Verapamil from the GI tract in toxicity? - gastric lavage followed by activated charcoal
DILTIAZEM - Blocks ca channels in heart and vessels like Verapamil - used for angina, essential hypertension, cardiac dysrhythmias
DILTIAZEM side effects: - less constipation than Verapamil most common: - dizziness - flushing - headache - edema of ankles and feet -Chronic eczematous rash
DILTIAZEM food and drug interaction - beta blockers - digoxin - grapefruit juice
NIFEDIPINE - Works on arterioles but NOT the heart
Indirect effects of NIFEDIPINE - Activated baroreceptor reflex (reflex occurs mainly with IMMEDIATE-RELEASE formulation of Nifedipine)
SAFETY ALERT NIFEDIPINE** - Immediate release has been associated with increased mortality in patients with MI & unstable angina
NET EFFECTS OF NIFEDIPINE 1. lowers BP 2. Increases HR 3. Increases contractile force
NIFEDIPINE uses: - Angina - Hypertension - Suppress preterm labor
NIFEDIPINE adverse effects: - Reflex tachycardia**:combine with beta blocker to prevent - flushing, dizziness, headache, peripheral edema, gingival hyperplasia
NIFEDIPINE drug interactions - Beta blockers (although used for relex tachycardia) - Toxicity can occur
Created by: KristinL