Calcium Channel Blocker

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Contents 1 More Specific Terms 2 Indications 3 Contraindications 4 Adverse-effects 5 Mechanism-of-action 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• amlodipine (Norvasc, Amlocard, Amvaz)
• bepridil (Vascor, Angopril, Cordium)
• clevidipine (Cleviprex)
• dihydropyridine Ca+2 channel blocker (CCB)
• diltiazem (Cardizem, Dilacor, Tiazac, Cartia, Angiotrofin, Dilcontin)
• felodipine (Plendil)
• flunarizine (Sibelium)
• isradipine (DynaCirc)
• nicardipine (Cardene, Cardene SR)
• nifedipine (Procardia, Adalat)
• nimodipine (Nimotop)
• nisoldipine (Sular)
• nitrendipine
• verapamil (Isoptin, Calan, Verelan, Covera-HS, Iproveratril, Dilacorin, Cardioprotect)

Indications

• hypertension
• supraventricular tachycardia
• atrial fibrillation/ flutter ( diltiazem, verapamil)
• Prinzmetal's angina
• hypertrophic cardiomyopathy

Contraindications

• left ventricular systolic dysfunction ( amlodipine may be OK)

Adverse-effects

• pedal edema
• bradycardia
• tachycardia
• orthostatic hypotension
• constipation
• GERD via lowering of esophageal sphincter tone
• urinary retention via relaxation of bladder smooth muscle
• eczema, prutitis (especially chronic therapy in elderly)
  

• Overdose:

• supportive therapy:

• IV access
• continuous cardiac monitoring

• bradycardia

• atropine generally not useful (not vagally mediated)
• glucagon recommended in [2], but not in [3]
• ventricular pacing

• hypotension

• calcium gluconate 3-9 g IV through peripheral line
• calcium chloride 1-2 g IV over 10 minutes through a central venous catheter is alternative (caution: sclerosing agent)
• high-dose insulin euglycemia therapy
• intra-aortic balloon pump
  

• drug adverse effects of calcium channel blockers

Mechanism-of-action

• blocks entry of calcium into cells
• inhibits contractility of smooth muscle
• dilation of blood vessels - increases coronary perfusion
• reduction in blood pressure - decreases afterload
• beneficial effect of diastolic relaxation
• negative inotropic effects ( diltiazem, verapamil)
• diltiazem & verapamil block the AV node; dihydropyridine CCBs do NOT

More General Terms

• vasodilator agent

Additional Terms

• antiarrhythmic agent, Group IV

References

1. Joly P et al, Chronic eczematous eruptions of the elderly are associated with chronic exposure to calcium channel blockers: Results from a cases-control study. J Invest Dermatol 2007, 127:2766 PMID: [1]
   - Stern RS Chronic medication use and inflammatory skin diseases: The power and limitations of the case-control study. J Invest Dermatol 2007, 127:2709 PMID: [2]
2. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
3. The Washington Manual of Medical Therapeutics, 33rd edition Foster C et al (eds) Lippincott, Williams & Wilkins, Philadelphia, 2010, pg 971

calcium channel blocker (CCB)