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Cardiac Depressants, Metabolic Modifiers and Slow Sodium Channel Inhibitors – Angina and Heart Failure Management

by Pravin Shukle, MD
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    Let's talk about the cardiac depressants like the calcium channel blockers. I'm going to use two prototypical calcium channel blockers, one from each class and explain how they work First, there is verapamil, which is a non-dihydropyridine calcium channel blocker. And there is nifedipine, which is a dihydropyridine calcium channel blocker. Now, the nifedipine will block L-type calcium channels. In the case of nifedipine, it causes vasodilation peripherally. And the case of verapamil, it causes vasodilation peripherally as well as cardiac suppression in the way that the heart is beating. So, there is less inotropy and less chronotropy. Now, side effects of these particular agents are constipation, pretibial edema, nausea, flushing and dizziness. Toxicity includes AV block. So, you can have sinus node depression, AV block, and this is usually from verapamil which has the most activity at the heart. Other cardiac depressants can be beta blockers. So, you talk about propranolol as the prototypical drug. And I've already mentioned beta blockers multiple times in previous lectures. Beta blockers reduce heart rate, cardiac force and blood pressure, and it's used in prevention only of angina. It is not for treating acute angina attacks. Remember that vasospastic forms of angina do not respond well to beta blockers. What beta blockers do is just reduce the oxygen demand that the heart is asking for. Let's talk about metabolic rate modifiers. These are relatively new agents. They are partial fatty acid oxidase inhibitors, or pFOX inhibitors. This increase the efficiency of oxygen utilization by the myocardium. It shifts the energy production from fatty acids to glucose. It may also have an effect on slow sodium channels in the heart, we are not entirely sure, but we do see a reduced heart rate, reduced contractile force, and we think, and in some studies it...

    About the Lecture

    The lecture Cardiac Depressants, Metabolic Modifiers and Slow Sodium Channel Inhibitors – Angina and Heart Failure Management by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:

    • Cardiac Depressants
    • Metabolic Rate Modifiers
    • Slow Sodium Channel Inhibitors

    Included Quiz Questions

    1. Verapamil and diltiazem, which cause cardiac depression at the AV node.
    2. Nifedipine and felodipine, which cause cardiac depression at the AV node.
    3. Metoprolol, which causes cardiac depression at the AV node
    1. ...include nifedipine.
    2. ...include diltiazem.
    3. ...include verapamil.
    4. ...include metoprolol.
    1. Verapamil
    2. Diltiazem
    3. Nifedipine
    1. ...shift metabolism from fatty acid oxidation to glucose.
    2. ...shift metabolism from glucose to fatty acids.
    3. ...shift metabolism from fatty acids to protein (gluconeogenesis).
    4. ...shift metabolism from oxygen to lactic acid.
    1. ...inhibits (reduces heart rate) by blocking the slow sodium channel.
    2. ...inhibits (reduces heart rate) by blocking the calcium channel.
    3. ...inhibits (reduces heart rate) by blocking the funny channel.
    4. ...inhibits (reduces heart rate) by blocking the potassium channel.

    Author of lecture Cardiac Depressants, Metabolic Modifiers and Slow Sodium Channel Inhibitors – Angina and Heart Failure Management

     Pravin Shukle, MD

    Pravin Shukle, MD


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