Professional Documents
Culture Documents
m
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p
m
are
4 relatively selective for
myocardium
4 reduce myocardial oxygen
demand
4 reverse coronary vasospasm,
and
4 often used to treat angina.
Example: Gallopamil
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à
are an
intermediate class between
phenylalkylamine and
dihydropyridines in their
selectivity for vascular
calcium channels.
Example: Diltiazem
p
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y èhile most of the agents listed above are relatively
selective, there are additional agents that are
considered nonselective.
y Example: mibefradil, bepridil and fendiline.
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Angina is not a disease itself but is the primary symptom
of coronary artery disease. It is typically experienced as
chest pain, which can be mild, moderate, or severe.
¢
The probable mechanism by which calcium channel-
blocking agents work in variant angina is the decrease
of the inappropriately stimulated tone of arterial
smooth muscle during coronary vasospasm.
Verapamil, nifedipine and diltiazem are all effective in
treatment of coronary spasm.
p
Nifedipine is the safest choice among the calcium channel
blockers for combination with beta blockers. It has also
been shown that nifedipine, along with verapamil and
diltiazem, has additional therapeutic effects when used
with propranolol for patients with chronic stable angina.
-
Studies of the long-term effectiveness of calcium channel
blockers in patients with unstable angina appear to reduce
the number of patients, who require bypass surgery for
relief of angina.
Verapamil has become the treatment of choice in re-entrant
supraventricular tachycardia
4
For patients with atrial fibrillation verapamil has been
shown to be effective in controlling the ventricular
response quickly and safely.
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It was found that only the L-type channels were sensitive
to calcium channel-inhibiting drugs. L-type calcium
channels are different in various tissues with respect to
their affinities for calcium antagonists. ppàs bind to
the receptors with higher affinity under depolarized
rather than polarized conditions.
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