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NURS 572 Pharm 44

Calclium channel blockers

normal physiology of calcium channel is COUPLED with B-1 receptors---epi/nor/agonist binds B-1---cAMP 2nd messenger opens Ca channel---Ca influx
once Ca in cell, what are heat targets/actions SA node/HR-----AV node/conduction velocity-----myocardium/force of contraction
B-1 receptors/Ca channels also located in artery smooth muscle, what is their action in arteries, normal action is to vasocon periph arteries/inc bp--------vasoCON coronary arteries/dec perfusion
so, when we BLOCK Ca channels, what is that effect on the heart Ca can't get in--> SA/DECREASED HR-----AV/DECREASED force of conduction-----myocardium/DECREASED force of contraction
when we BLOCK Ca channels in arteries, what is effect arteries vasoDIL--> increased coronary perfusion---peripheral vasoDIL/dec bp
two classes of calcium channel blockers dihydropyridines ---- other class (verapamil, diltiazem)
MOA of verapamil (other class, drug 1) blocks Ca channels in BOTH artery VSM (vascular smooth muscle) AND heart. net effect to dec bp/inc cardiac perfusion and dec HR/conductivity/force of contraction
verapamil indiacted for indicated for essential HTN, CAD, angina pectoris, dysrhyth, tachy, migraine prophylaxis
compliance limiting SE verapamil constipation - also blocks GI Ca channels
SEs we would expect from verapamil based on MOA expect CARDIAC SEs ----overshoot if too high of dose-------brady----heart block (too little conduction)
Lesser SEs expected from verapamil vasodil--> flushing/diz/HA/mild periph edema-------GINGIVAL HYPERPLASIA
MOA of diltiazem (other class, drug 2) MOA is similar to verapamil with less potent effects on heart -----sim action on VSM to dec bp, inc coronary perfusion
are verapamil and diltiazem safe for RF pts yes, they are metabilized in the liver
MOA of dihydriopyridienes = DHPs----AKA dipines they ONLY act on B-1/Calcium channels on VSM. NO, NONE, NADA, ZIP action on heart except baroreceptor reflex which I am not getting into
DHP - dihydropyridine indicated for HTN and angina pectoris. No indications for cardiac
ADRs DHP dihydropyridine ANKLE EDEMA-----flush/HA/dizz ---some reflex tachy bwo inotropic effects, which we are not discussing
Name 6 DHPs ---dihydropyridines meet the dipine family---clevidipine---nisoldipine---felodipine---amlodipine---isradipine---nicardipine
what 1 DHP is ONLY, ONLY, ONLY to be used to prevent cerebral vasospasm in subarachnoid bleeds nimodipine
primary MOA of DHPs major role block B-1/Ca Channels in VSM. Virtualy no direct effect on heart (indirect, but I am so not talking about it)
DHP given IV only clevidipine
DHP 5% bioavailability nisoldipine
DHP 20% bioavailability felodipine
DHP very long acting amlodipine
DHPs - 2 - nothing remarkable isradipine, nicardipine
DHP that can't be used for HTN nimodipine - only subarachnoid bleed-prevent vasospasm
What CCB has MOST ADRs verapimil wins this prize
which CCB has middle ADRs diltiazem is runner up
which CCB class has least ADRs DHP class of dihydropiridines = dipines has fewest ADRs
which CCB is most likely to cause ADR of heart block verapamil, followed by diltiazepam
which CCB is most likely to cause constipation verapamil, less likely diltiazepam
which CCB is most likely to cause ankle edema any DHP dipipine . . .except nimodipine which is only used for . . .you know it already! quiz answer was nifedipine
Created by: lorrelaws