Pharm
Calcium Channel Blocker
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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-Dihydropyridine
s 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
Diuretic
s
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
Gene
ral
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
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