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Calcium Channel Blockers (Dihydropyridines
Nifedipine
Amlodipine (MOA,…
Calcium Channel Blockers
MOA
Mainly Arterial SM Activity
- vasodilatation (inc. coronary)
- particularly pre-capillary arterioles
↓TPR → ↑ sympathetic tone → ↑ HR
SE
Flushing
Headache
Ankle oedema
- esp. amlodipine
Dizziness
↓ BP
Gingival hypertrophy
- esp. nifedipine
-
Risk of ↓↓BP c¯ α/β-BFx ↑d by grapefruitFx ↓d by:
- Rifampicin
- CBZ + phenytoin
Nifedipine only
Indications
- Angina
- Prinzmetal’s angina
- HTN
- Raynaud’s
-
Interaction
Risk of AV block, HF and
asystole c¯ β-blockers.
↑s fx of digoxin
Fx of verapamil ↑d by:
- Grapefruit juice
- Macrolides
↑ risk of myopathy c¯
simvastatin
-
Indications
- Angina
- HTN
- Arrhythmias (Verap)
MOA
Mainly Cardiac Activity
- -ve inotropic effect (esp. verapamil)
- verapamil also slows conduction @
SA and AV nodes
Some activity @ arterial SM (<DHPs)
Indications
-
Nifedipine MR and Amlodipine
- HTN (long-acting)
- Angina: esp. good for Prinzmetal’s
- Raynaud’s
-
Effects
All CCBs are vasodilators: ↓ afterload
- Also dilate coronary arteries
- Pre-capillary vasodilatation → transudative oedema
Dihydropyridines act only @ arterial SM and can → reflex tachycardia
- Avoid short acting preparations
-
Verapamil is also negatively chronotropic
-