CCBs

Question 1

MOA - general

Answer 1

• Blocks Ca from entering the muscle cells of heart and arteries
• Muscle relaxation = arteries widen
• Reduces pressure

Question 2

Types of CCB

Answer 2

1. RL - V,D
2. Dihydropyridines - A, F, N

Question 3

Dihydropyridines vs RL

Answer 3

• • influence on vessels
• less on mycoardium

Question 4

Effects of RL CCB

Answer 4

• Vasodilatory
• • decrease myocardial contractility + HR
• Highly negative inotropic effects (weaken force of muscle contraction of the heart)

Question 5

Which CCB should be avoided in HF

Answer 5

• RL
• Decrease myocardial contractility
• In HF, contractility is weakened already

Question 6

Can you give
the dihydropyridine CCBs in heart failure?

Answer 6

• Avoid short acting (nifedipine)
• NICE CKS recommends Amlodipine (or Felodipine) in heart failure
• Safest: amlodipine

Question 7

Which dihydropyridine
CCB is short-acting?

Answer 7

• Nifedipine
• This is why they are commonly prescribed as
  Modified release preparations
• Since they are short-acting, they MUST be avoided in heart failure

Question 8

Which dihydropyridine CCBs are long-acting?

Answer 8

Amlodipine
Felodipine

Question 9

Verapamil + BB

Answer 9

Avoid - brady + cardiodepression

Question 10

Verapamil - common SE

Answer 10

Constipation

Question 11

Which has a better negative inotropic effect, Verapamil or diltiazem?

Answer 11

Verapamil
more likely to cause significant myocardial depression

Question 12

Can Diltiazem be taken with Beta-blockers?

Answer 12

• Caution + specialist
• Although it has a negative inotropic effect (so there is a risk of bradycardia), the effects are not as great as Verapamil

Question 13

Dihydropyridines - SE

Answer 13

• **Ankle swelling/oedema **
• Headache
• flushing

Question 14

Does the oedema side effect of the
dihydropyridine CCBs
respond to diuretics?

Answer 14

• They only respond partially to diuretics

Question 15

Ankle swelling switch to

Answer 15

• alternative CCB
• from Amlodipine to Felodipine) if they complain about ankle swelling

Question 16

Dihydropyridines + BB

Answer 16

Yes

Question 17

Special warning for
CCBs

Answer 17

• AVOID ABRUPT WITHDRAWAL (May precipitate myocardial ischaemia)
• Avoid Grapefruit juice as it prevents clearance of CCBs (mild study)

Question 18

What are some interactions with CCBs?

Answer 18

1. Statins
2. Dabigatran + verapamil
3. Carbamazepine
4. BB + verapamil
5. Grapefruit
6. Macrolides (V, D)

Question 19

What strength of MR
Diltiazem should be prescribed by brand?

Answer 19

more than 60mg MODIFIED RELEASE tablets or capsules
So e.g. Tildiem 90, Tildiem 120
you don’t need to specify brand for immediate release

Question 20

Which CCBs must be prescribed by brand?

Answer 20

• Diltiazem MR tablets strength of more than 60mg
• Nifedipine MR - any strength
• This is because different modified release preparations don’t have the same clinical effect