Calcium Channel Blockers: Dihydropyridines vs Non-Dihydropyridines

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Questions and Answers

What is the primary mechanism of action for non-dihydropyridines?

  • Selective activation of L-type calcium channels in the heart.
  • Selective blockade of L-type calcium channels in vascular smooth muscle.
  • Selective enhancement of calcium influx in cardiac myocytes.
  • Non-selective inhibition of L-type calcium channels in both vascular smooth muscle and the heart. (correct)

Which of the following is a potential adverse effect specifically associated with verapamil?

  • Gum swelling
  • Flushing
  • Constipation (correct)
  • Peripheral edema

How do dihydropyridines primarily affect systemic vascular resistance (SVR)?

  • Increase SVR in hypertensive patients and decrease SVR in normotensive patients
  • Have no significant effect on SVR
  • Decrease SVR (correct)
  • Increase SVR

Which of the following conditions is a relative contraindication for the use of non-dihydropyridines?

<p>Heart failure (C)</p> Signup and view all the answers

Which of the following best describes the antiarrhythmic mechanism of non-dihydropyridines?

<p>Slowing conduction through the AV node. (A)</p> Signup and view all the answers

A patient is prescribed amlodipine for hypertension but develops noticeable peripheral edema. Which of the following is the MOST appropriate initial step?

<p>Reduce the dose of amlodipine. (A)</p> Signup and view all the answers

In which clinical scenario would a non-dihydropyridine calcium channel blocker be MOST appropriate?

<p>A patient with supraventricular tachycardia and hypertension. (A)</p> Signup and view all the answers

What is the primary reason non-dihydropyridines are relatively contraindicated in patients taking beta-blockers?

<p>Increased risk of significant heart block and bradycardia. (B)</p> Signup and view all the answers

Which of the following hemodynamic effects is MOST characteristic of dihydropyridine calcium channel blockers?

<p>Significant vasodilation in peripheral vasculature (C)</p> Signup and view all the answers

How might non-dihydropyridines impact a patient's digoxin level, and why?

<p>Increase digoxin levels by inhibiting P-glycoprotein transporters. (D)</p> Signup and view all the answers

A patient with hypertension and Raynaud's phenomenon is considering a calcium channel blocker. Which class would likely be MORE beneficial and why?

<p>Dihydropyridines, due to their vasodilatory effects on peripheral vasculature. (C)</p> Signup and view all the answers

What is a key difference in the binding affinity of dihydropyridines compared to non-dihydropyridines?

<p>Dihydropyridines bind with higher affinity to vascular L-type calcium channels. (A)</p> Signup and view all the answers

A patient with a known allergy to amlodipine needs a calcium channel blocker for hypertension. Which of the following is LEAST appropriate?

<p>Feldopidine (B)</p> Signup and view all the answers

What physiological effect of non-dihydropyridines makes them useful in controlling certain types of arrhythmias?

<p>Decreased AV nodal conduction velocity. (B)</p> Signup and view all the answers

In a patient with hypertension and chronic kidney disease, which calcium channel blocker class might be preferred and why?

<p>Dihydropyridines, because they do not cause renal vasoconstriction. (C)</p> Signup and view all the answers

What is the primary advantage of using amlodipine over other dihydropyridines in managing hypertension?

<p>Longer half-life, providing sustained blood pressure control. (B)</p> Signup and view all the answers

Which of the following scenarios warrants careful monitoring for hypotension when initiating a dihydropyridine calcium channel blocker?

<p>Patient with hypovolemia. (B)</p> Signup and view all the answers

What property of non-dihydropyridines makes them less suitable for patients with left ventricular systolic dysfunction?

<p>Their negative inotropic effect (C)</p> Signup and view all the answers

A patient on verapamil reports new-onset muscle weakness and fatigue. What electrolyte abnormality should be suspected?

<p>Hypokalemia (B)</p> Signup and view all the answers

What advice should be given to a patient starting on nifedipine to minimize the risk of reflex tachycardia?

<p>Start with a low dose and titrate slowly. (A)</p> Signup and view all the answers

Which of the following calcium channel blockers is LEAST likely to cause significant drug interactions due to CYP3A4 inhibition?

<p>Amlodipine (C)</p> Signup and view all the answers

A patient taking a dihydropyridine calcium channel blocker complains of gingival hyperplasia. What is the most appropriate course of action?

<p>Improve oral hygiene and consider switching to another antihypertensive if the problem persists. (A)</p> Signup and view all the answers

When are non-dihydropyridines like diltiazem and verapamil contraindicated? (Select all that apply)

<p>2nd or 3rd degree AV block (A), Heart Failure (D)</p> Signup and view all the answers

What are the common side effects of Dihydropyridines like Amlodipine and Felodipine? (Select all that apply)

<p>Gum Swell (B), Headache (C)</p> Signup and view all the answers

A patient presents with both hypertension and a history of migraine headaches. Which calcium channel blocker might be considered and why?

<p>A non-dihydropyridine as some have shown benefit in migraine prophylaxis. (D)</p> Signup and view all the answers

A patient on a non-dihydropyridine calcium channel blocker needs to start on erythromycin for a bacterial infection. What is the PRIMARY concern?

<p>Erythromycin inhibits CYP3A4, potentially increasing the calcium channel blocker's levels. (A)</p> Signup and view all the answers

Which calcium-channel blocker would primarily lower heart rate and conduction?

<p>Non-Dihydropyridines (C)</p> Signup and view all the answers

What is the best method to deal with Angina pectoris?

<p>Give Dihydropyridines, such as Amlodipine and Felodipine (C)</p> Signup and view all the answers

What do Dihydropyridines work to inhibit?

<p>L-Type Ca2+ Channels in vascular smooth muscle (A)</p> Signup and view all the answers

How does non-selective calcium channel inhibition by drugs like verapamil and diltiazem impact myocardial oxygen demand?

<p>Decreases myocardial oxygen demand by reducing afterload and contractility (D)</p> Signup and view all the answers

Which of the following is the most likely explanation for why dihydropyridines are more associated with peripheral edema than non-dihydropyridines?

<p>Dihydropyridines selectively dilate pre-capillary arterioles, increasing capillary hydrostatic pressure. (C)</p> Signup and view all the answers

A patient with variant (Prinzmetal's) angina is prescribed a calcium channel blocker. Which class is more appropriate and why?

<p>Dihydropyridine, as they are more potent vasodilators (D)</p> Signup and view all the answers

What are the indications for Non-Dihydropyridines, like Verapamil and Diltiazem? (Select all that apply)

<p>Arrhythmia (A), Stable Angina (B), Hypertension (C)</p> Signup and view all the answers

What are the main drugs classes of Ca2+ Channel Blockers?

<p>Dihydropyridines and Non-Dihydropyridines (A)</p> Signup and view all the answers

Why would Beta Blockers be contraindicated, if a patient is taking non-dihydropyridines?

<p>The possible increased risk of significant heart block and Bradycardia. (B)</p> Signup and view all the answers

What two drugs come under the Dihydropyridines family of drugs? (Select 2)

<p>Felodipine (A), Amlodipine (B)</p> Signup and view all the answers

What do Dihydropyridines lead to?

<p>Decreased SVR or Systematic Vascular Resistance. (D)</p> Signup and view all the answers

Which type of drug leads to Hypertension and Angina pectoris?

<p>Dihydropyridines. (B)</p> Signup and view all the answers

Which of the following calcium channel blockers is MOST likely to cause constipation as a side effect?

<p>Verapamil (A)</p> Signup and view all the answers

A patient with hypertension is prescribed verapamil. Which of the following pre-existing conditions would raise the GREATEST concern regarding the initiation of verapamil therapy?

<p>Heart failure with reduced ejection fraction (HFrEF) (D)</p> Signup and view all the answers

A cardiologist is determining the most appropriate calcium channel blocker for a patient. Considering their differing mechanisms, which factor would be MOST important when choosing between a dihydropyridine and non-dihydropyridine?

<p>Whether the primary goal is afterload reduction versus heart rate control (A)</p> Signup and view all the answers

A patient taking diltiazem reports experiencing persistent constipation. Which of the following strategies is LEAST likely to provide relief without compromising their antihypertensive therapy?

<p>Initiating a daily regimen of magnesium citrate (D)</p> Signup and view all the answers

A patient with a history of sick sinus syndrome develops symptomatic bradycardia while being treated for hypertension. Which antihypertensive medication is MOST likely contributing to this adverse effect?

<p>Diltiazem (C)</p> Signup and view all the answers

A patient with stable angina and hypertension is prescribed a calcium channel blocker. Which of the following combinations of physiological effects makes non-dihydropyridines particularly useful in this scenario?

<p>Decreased heart rate and decreased myocardial contractility (B)</p> Signup and view all the answers

Flashcards

Non-Dihydropyridines

Non-dihydropyridines that include Verapamil and Diltiazem.

Mechanism of NDHPs

Non-selective, inhibit L-type Ca2+ channels in vascular smooth muscle and the heart (AV/SA node).

Side Effects of NDHPs

Bradycardia, arrhythmia, AV block, constipation (verapamil).

Indications for NDHPs

Hypertension, arrhythmia, stable angina.

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Contraindications for NDHPs

2nd/3rd degree AV block, heart failure, hypotension, beta-blocker use.

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Dihydropyridines

Dihydropyridines include Amlodipine and Felodipine.

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Dihydropyridines Mechanism

Selectively inhibit L-type Ca2+ channels in vascular smooth muscle, causing decreased SVR.

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Side Effects of Dihydropyridines

Peripheral edema, gum swelling, headache, dizziness, flushing.

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Dihydropyridines: Indications

Hypertension, angina pectoris

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Contraindications for Dihydropyridines

Heart failure, hypotension

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Study Notes

  • Ca2+ channel blockers include dihydropyridines and non-dihydropyridines

Dihydropyridines

  • Drugs include Amlodipine and Felodipine
  • Inhibit L-type Ca2+ channels in vascular smooth muscle
  • Systemic Vascular Resistance (SVR) decreases
  • Adverse Effects include peripheral edema, gum swelling, headache, dizziness, and flushing
  • Used to treat hypertension and angina pectoris
  • Contraindicated in heart failure (HF) and hypotension

Non-Dihydropyridines

  • Drugs include Verapamil and Diltiazem
  • Non-selective; inhibit L-Type Ca2+ channels in vascular smooth muscle and heart, specifically the Atrioventricular (AV) and Sinoatrial (SA) nodes
  • Contractility decreases
  • Heart Rate (HR) decreases and conduction decreases
  • Possess antiarrhythmic properties
  • Adverse effects include bradycardia, arrhythmia, AV block, and constipation if taking Verapamil
  • Used in the treatment of Hypertension, Arrhythmia, and stable angina
  • Contraindicated in 2nd or 3rd degree AV block, Heart Failure (HF), Hypotension, and when taking a beta blocker

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