Cardio pharm- Ca channel blockers, vasodilators

nifedipine, nicardipine, amlodipine, felodipine are

dhydropyridines

nondihydropyridines

venous dilators

arterial dilators

alpha1 blockers

dihydropyridines (a type of calcium channel blockers)

cram the pance mneumonic for ca channel blockers- cut down ZEM PINES and put zem in the MILL

so ca channel blockers end in

ZEM (diltiazem)

PINE (ex: amlodipine)

MIL (verapamil)

there are 2 types of calcium channel blockers

we have dihydropyridines (our PINES)

and our non dihydropyridines (NON PINES)- verapamil, diltiazem

*VERY IMPORTANT*

difference bw dihydropyridine and non dihydropyridine CCBs

dihydropyridines (our PINES- amlodiPINE, etc) lower BP VASODILATING our vessels

nondihydropyridines vasodilate AND DECREASE CARDIAC VELOCITY aka they're cardiac depressants

DV DV

Diltazem and Verapamil Decrease Velocity of heart

which HTN med can also be used for migrain prophylaxis

Verapamil

which type of CCB can treat arrythmias like SVT

non dihydropyridines aka verapamil and diltiazem bc these DECREASE VELOCITY of heart

gingival hyperplasia is an AE for which type of HTN meds

thiazides

loops

ARBs

ca channel blockers

think CA channel blockers cause teeth issues, when i think of teeth I think of CAvities, and gingival hyperplasia is a dental issue whicih reminds me of cavities idk this helps me remember

flushing and reflex tachycardia is an AE for

dihydropyridines

non dihydropyridiens

dihydropyridines- why? bc dihydropyridines CCBs VASODILATE, which increases blood flow to skin, so FLUSHING, and the intense vasodilation also lowers BP dramatically wihch triggers the body's baroreceptors to increase HR (aka reflex tachycardia) in an attempt to compensate for the drop in BP

why is headache an AE for dihydropyridine CCBs

bc of the vasodilation (When blood vessels in the head, especially those near the brain, dilate, it stretches the sensory receptors in the vessel walls, sending pain signals to the brain aka headache)

T/F: bradycardia and constipiation are AEs for all ca2+ channel blockers

F- mainly for the ones that lower heart rate aka the non dihydropyridines ( Diltiazem and Verapamil which Decrease Velocity of heart)

T/F: organic nitrates (nitroglycerin) are venous dilators are low doses and at higher doses can also dilate arteries

T

why would a throbbing headache and flushing be common AEs of nitro

bc like any other vasodilator , it VASODILATES aka we are increasing blood flow to skin (cause of flushing) and increasing blood flow to head (headache)

why would nitroglycerin be contraindicated in someone w aortic stenosis or hypertrophic or restrictive cardiomyopathy?

can we give nitro for all MIs? if not, which ones can we NOT

bc in these conditions we are having trouble getting enough blood to the heart or pumping out blood, so if we give nitro, were decreasing preload and making it even harder for the heart to do its job

NO NITRO FOR RIGHT SIDED MI/INFERIOR MI (bc most inferior MIs have right ventricular involvement)

arterial dilators work by

increasing preload

decreasing preload

increasing afterload

decreasing afterload

decreasing afterload

think AD DA

Arterial Dilators Decrease Afterload

what does this mean? we are decreasing the resistance or pressure that the heart's ventricles must overcome to eject blood during systole. It essentially makes it easier for the heart to pump blood out, improving cardiac output.

minoxidil is a

venous dilator

arterial dilator

beta blocker

alpha blocker

arterial dilator

this makes sense!!! think of topical minoxidil for hair growth- working at a derm office whenever someone asked how it worked, we would tell them how it increases blood flow to ur hair follicles- aka it dilates the arteries supplying ur hair follicles, so its aN ARTERIAL DILATOR

its the same thing with oral minoxidl for blood pressure- it dilates the arteries by opening K+ channels, leading to K+ efflux, leading to HYPERPOLARIZATION which inhibits Ca2+ influx, which PREVENTS THE ARTERIES FROM CONTRACTING AKA THEY ARE STAYING OPEN/DILATED

_____________ should be prescribed along with a beta blocker to prevent reflex tachycardia

minoxidil- why?

Minoxidil is a potent arterial dilator, which can lead to a rapid increase in heart rate (reflex tachycardia) due to the body's compensatory mechanisms. To manage these side effects, we often prescribe a beta blocker to decrease HR to prevent these side effecrs

what are the 2 boxed warnigns for minoxidil

to prescribe w close supervisoin/and use with a beta blocker

pericardial effusion, tamponade, exacerbates angina

Minoxidil can exacerbate angina (chest pain due to reduced blood flow to the heart) because it can increase heart rate and cardiac output, leading to higher oxygen demands on the heart. This can be problematic for individuals with existing coronary artery disease, as their heart may not be able to meet the increased oxygen demand, triggering or worsening angina

________ can cause lupus like syndrome, especially in slow acetylators

Hydralazine ( a type of arterial dilator)

think hydraluuuzeine

luuupus like symptoms

tolerance and tachyphylaxis are AEs of which direct vasodilator

hydralazine

what is the mixed vasodilator and what does that mean

mixed means it can dilate veins and arteries, and it is Na nitroprusside

moa for this med is that it is an NO donor, increases cGMP, thus causing arterial and venous dilation

what is the boxed warning for this med?

Na nitroprusside

this med has the word NITRO in it so we know its a vasodilator- its can be used for hypertensive emergency

its IV, and must be given at a brief or low rate bc of how quickly it starts working

note- na nitroprusside can also cause cyanide toxicity!! boxed warning too

which vasodilator has a boxed warning for IV infusion that u must use at a brief or low rate bc of how fast it acts

Na nitroprusside

which HTN med has a risk for cyanide toxicity (boxed warning)

Na nitroprusside

think prusssssssside

ssssssyonide toxicity (i know cyonide is spelled with a c but this helps me remember)

IMPORTANT, THIS WAS MOSTLY DISCUSSED IN CLIN MED BUT STILL

dihydropyridines CCBs like amlodipine can cause what side effect

lower extremity edema