powerpoint presentation 5/sectio… · ppt file · web view · 2014-11-07calcium antagonists...
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Calcium antagonists(calcium channel blockers)
They block calcium influx through voltage-dependant calcium channels in the smoothmuscles. They dilatecoronaries andperipheral arteriesand reduceheart afterload.
VDCC ROCC
Receptor
AP
Ca2+
Ca2+
Sarcoplasmaticreticulum
Cellwall
NA
(–)
Calciumantagonists
AP – action potential, NA – noradrenalineVDCC – voltage-dependent calcium channelsROCC – receptor operating calcium channels
In the cell membranes there are three types of calcium channels: Voltage-dependent (L, N, O, P, Q, R, T) Receptor operating Stretch activated
Calcium antagonists block predominantly L-typecalcium channels, localized in the myocardiumand myocytesof bloodvessels.L-type channelsare connectedto the plateauof the AP.
Plateau phase of AP
Calcium antagonists reduce coronary and peripheral vascular resistance, decreaseblood pressure and myocardial oxygenconsumption.
Dihydropyridines (nifedipine, amlodipine,etc) don’t have cardionegative inotropic, chronotropic, and dromotropic effect incomparison with verapamil and diltiazem.
Dihydropyridines ● Norm frequent (with normal heart rate) and24-hours long effect: Amlodipine, Felodipine ● Other dihydropyridines produce tachycardia (increase baroreflex sensibility): Isradipine, Lacidipine, Nicardipine, Nifedipine, Nisoldipine, Nitrendipine ● cerebral vasodilators (Nimodipine) Phenylalkylamines: Verapamil Benzotiazepines: Diltiazem Flunarizine type (cerebral vasodilators) Cinnarizine, Flunarizine
Arterial hypertensiona) Dihydropyridinesb) Verapamil and Diltiazem
Coronary heart diseasea) Dihydropyridinesb) Verapamil and Diltiazem
Ischemic cerebral strokeCinnarizine, Flunarizine, Nimodipine
SV tachyarrhythmias: Verapamil, Diltiazem (i.v.) Migraine (in remission periods)
Flunarizine, Verapamil
Beta-blockers + dihydropyridines: YES (OK)Beta-blockers + Verapamil or Diltiazem = NO
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Amlodipine norm frequent dihydropyridinet1/2 31–47 h, 55–91% p.o. bioavailability5–10 mg/24 h p.o. (once daily)
Nifedipine (tachycardia!)– effective in vasospastic angina
Diltiazem (in SR dosage forms)Verapamil (Isoptin SR® – tabl. 240 mg)
(22% p.o. bioаvailability, first pass effect –extensive liver metabolism)
Class IV antiarrhythmic drugs
Indications: SV tachyar- rhythmias
ARs: headache, ankle swelling,bradycardia, AV block, negativeinotropic effect (decreasingcardiac contractility)
Mainly verapamil (p. o./i. v.) and diltiazem (only i.v.) has specific action on ..the… SA and AV node (they shorten AP)
ARs of calcium antagonists•Arterial dilation: headache, flush, dizziness,ankle swelling (resistant to treatment with diuretics but not with ACE inhibitors).•Bradycardia and AV block (verapamil).•Verapamil + beta-blockers: potentiate cardiodepression.•Tachycardia (nifedipine, nisoldipine).•Constipation (verapamil 8%; nifedipine 3%)•Haemorrhagic gingivitis