First line hypertensives: Dihydropyridine Calcium Channel Blockers (DHP CCP) and NON DHP CCP

DHP CCB (dihydropyridine calcium channel blockers)

block L-type calcium channels in vascular smooth muscle causing the blood vessels to dilate and lowering BP

suffix of DHP CCB

dipine

calcium role

enters smooth muscle causing the muscles to contract and the vessels become narrower increasing BP and resistance

pathway of amlodipine (DHP CCB)

amlodipine → Ca cant enter muscle easily → smooth muscle cant contract as strongly → smooth muscle relaxes → blood vessels widen (vasodilates) → lower resistance and lower BP

contraindications of DHP CCB

none

black box warning of DHP CCB

none

ADR (common)

peripheral edema (swelling in legs/arm) and pulmonary edema

ADR (rare)

hepatoxicity and thrombocytopenia

why peripheral edema happens

increased pressure in tiny capillaries downstream causing fluid to move from blood to surrounding tissue

counseling points of DHP CCB

dizziness and report signs of peripheral edema

examples of DHP CCB

nifedipine, amlodipine, and felodipine

Non DHP CCB

non specific medication that effects blood vessels and heart by inhibiting calcium ions going into channels of vascular smooth muscle and myocardium during depolarization

examples of Non DHP CCB

verapamil and dilitezam

3 effects of Non DHP CCB

blood vessels relax, slows heart rate, and slows heart beat

heart rate slows down

dilitazem blocks Ca entry → SA node fire slowly → heart rate slows down (negative chronotropic)

SA nodes

determines heart rate

Slows heart beat

dilitazem blocks calcium channels in AV nodes → electrical signals travels more slowly → slower AV conduction

AV nodes

carries electrical signals from atria to the ventricles, can help prevent ventricles from eating too fast

indications of non dhp ccb

antihypertensives, angina, and atrial arrhythmia

contraindications of non dhp ccb

heart block bc it already slows down the heart

ADR (common) of dhp ccb

peripheral edema, pulmonary edema, and headache

ADR (rare) of dhp ccp

heart failure, heart block, and hepatoxicity

counseling points

dizziness and follow correct instructions for specific brands

DHP vs Non DHP

non impacts both heart and vasculature → blocks AV node and dilates

dhp on impacts vasculature → dilation