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Calcium Channel Blocker
Aka: Calcium Channel Blocker
- See Also
- Calcium Channel Blocker Overdose
- Dihydropyridine Calcium Channel Blocker (e.g. Amlodipine, Nifedipine)
- Non-Dihydropyridine Calcium Channel Blocker (e.g. Diltiazem, Verapamil)
- Non-selective Calcium Channel Blocker (e.g. Mibefradil)
- Mechanism
- Cellular channel effects
- Effects slow calcium channel activity (blocks voltage-gated L-type calcium channels)
- Agents block both calcium and Sodium inflow into cells during action potential phase
- Channels present in cardiac and vascular smooth muscle
- Calcium Channel Blocker effects
- Myocardial relaxation (Non-Dihydropyridines primarily)
- Vascular smooth muscle relaxation
- Pancreatic B-islet cell inhibition
- Adverse Effects: Myocardial Infarction
- Short Acting Calcium Channel Blockers
- Findings
- Myocardial Infarction Risk: 60% over Diuretics
- Higher dose confers >3x risk of lower dose
- References
- Psaty (1995) JAMA 274:620-5, 654-5 [PubMed]
- Furberg (1995) Circulation 92: 1326-31, 1068-73 [PubMed]
- Long acting Calcium Channel Blockers
- No increased cardiovascular disease risk
- Reference
- Alderman (1997) Lancet 349:594-8 [PubMed]
- Adverse Effects: Bleeding risk
- Findings
- Higher Incidence of GI Hemorrhage in elderly
- Associated with platelet aggregation inhibition
- Avoid in older patients if:
- Peptic Ulcer Disease
- Concurrent Aspirin use
- Perioperative
- References
- Pahor M (1996) Lancet 347:1061-5 [PubMed]
- Wagenknecht (1995) BMJ 310(6982):776-7 [PubMed]
- Zuccala (1997) BMJ 314:643-4 [PubMed]
- Adverse Effects: General
- Hypotension
- Flushing
- Nasal congestion
- Tachycardia
- Dizziness
- Nausea
- Nervousness
- Bowel changes
- Gingival Hyperplasia
- Eczematous Dermatitis (or other skin reactions)
- Occurs in up to 1% of patients on Calcium Channel Blockers
- Delayed onset at 3 months after starting Calcium Channel Blockers
- Joly (2007) J Invest Dermatol 127(12):2766-71 [PubMed]
- Types
- Dihydropyridine (e.g. Nifedipine)
- Primary effects are on peripheral vasculature
- Non-Dihydropiridine
- Effect both peripheral vasculature and cardiac tissue
- Phenylalkamine (Verapamil)
- Benzothiazapine (Diltiazem)
- Protocol
- Monotherapy
- Diltiazem
- Verapamil
- Combination with Beta Blocker (Coronary Artery Disease)
- Nifedipine
- Bradycardia or Left Ventricular Dysfunction
- Amlodipine
- Felodipine
- Isradipine
- References
- Yen (2015) Crit Dec Emerg Med 29(10): 18-23