Calcium channel blockers CCB side effects in easy way let us discuss side effects of calcium channel blockers in easy way. Calcium channel blockers are commonly known as CCBs. We have three category of calcium channel blockers. The first one is the Verapamil, second one is diltiam.
And third group of drugs are belonging to dihedropidine category including the drugs like Nifidipin, Amlodipin isradipin, Nicodepin, Phyllodipin. In this way we have so many types of dihydropyridines, all these drugs are classified as calcium channel blockers with a common target Ltype calcium channels.
CCBs are going to block Ltype calcium channels so that calcium cannot enter through these channels into the membrane. That’s why sometimes these drugs are also considered as calcium channel antagonists. But actually they are not acting on the receptors.
They’re physiologically blocking the calcium channels. These Ltype calcium channels are widely distributed. Few of these calcium channels are present on the heart and few of the calcium channels are present on the vascular smooth muscle and other smooth muscles. So all these drugs are not similar in their form class connections. Few of the drugs are acting on vascular smooth muscle and few of the drugs are acting on cardiac muscle.
Calcium channel blockers CCB side effects in easy way
Specifically, here in the Verap mill we can denote the letter V. And V is not for the vascular smooth muscle. That means Verap mill is not acting on the vascular smooth muscle, instead it is acting on cardiac muscle. So this drug blocks the Ltype calcium channels present on the heart. On the other hand, nipidipine acts on the Ltype calcium channels present on vascular smooth muscle where it produces vasodilation.
And in the diltiasm we can find the letter D which can be remembered as dual action. So Diltiasm can block the Ltype calcium channels expressed on both hot as well as vascular smooth muscle. Even these drugs are acting on Ltype calcium channels, but their location of action is different verapolis acting on the heart, nipodipin and other dihidopridins are acting on vascular smooth muscle. And Diltiasm can act on both hot as well as vascular smooth muscle. Because of small difference in their location, they produce different side effects.
But all the side effects of calcium channel blockers can be easily remembered. So in this video we are going to discuss how easily we can remember the side effects of calcium channel blockers with a simple mnemonic. So now let us see the side effects of calcium channel blockers. Ltype calcium channels are present on the heart where they are responsible for contraction of the heart. And these ion channels are also expressed on vascular smoothmorgil responsible for vasoconstriction.
Now, whereab Mill is selective for the heart, it can block the Ltype casin channels on the heart resulting in the decreased rate of contraction leading to brady cardia. On the other hand, nipidipin and other dihydropidines can act on the vascular smooth muscle resulting in vasodilation. This vasodilation leads to tachycardia, but it is a reflux action. Here we can simply see that both verapmil and nipidipine are calcium channel blockers, but verapin produce brady cardia, whereas nipidipin produce tachycardia. The tachycardia produced by dihidropidins is an indirect action.
The vasodilation produced by these drugs results in the decreased blood pressure, and when the blood pressure is going to be reduced, it results in the decreased perfusion pressure.
This results in the activation of Barrow receptor reflex which stimulates the CNS to release the cataclymides. These catecholamines can act on the heart, resulting in the increased rate of contraction, leading to reflux tachycardia. In this way, dihidopridins produce reflux tachycardia due to their indirect action, whereas verapmin produce brady cardia because of its direct action on the heart. This simple difference between the side effects of verappil and nephidipine other side effects can be easily remembered with a simple mnemonic.
We can remember these side effects as B two H. Every letter indicates one side effects of these calcium channel blockers. So here B indicates brady cardia, c is the constipation, D is the Diginous, E is the Edema, F is the flushing, g is the gingival hyperplasia and H is the hypotension. In this way, the side effects of CCBs can be remembered with the letters B two H, b brady cardia, c constipation D Diginess E, Edema F, flushing G, gingival hyperplasia and H. Hypotension.
Most of these side effects are associated with hypotensive actions of calcium channel blockers. Now let us go one by one and let us discuss which type of CCBs produce these side effects. The first one is a brady cardia. All we have discussed that verapil produce brady cardia because this drug directly acts on the heart. Similarly, diltiasm can act both on the heart as well as vascular smooth musil.
Since these drugs act on the heart and block the ltype calcium channels, both verapil and diltiasm can produce brady cardia as one of the important side effect. On the other hand, nipidipine, Amlodipin and other dihidropidins can produce reflux tachycardia. Second one is a constipation. This constipation is mainly observed with the drug Verapamil. Verap Mil can block the Arithpe calcium channels present on the colon, so this drug can reduce the gastrointestinal motility.
Therefore, Verap Mil produce constipation as one of the important side effect. So this constipation is more pronounced with verapmil and less observed with dihidropidins as well as Diltiazm. But other calcium channel blockers can produce abdominal pain as another side effect. Third one is a Diginess. All the CCBs can produce hypotension.
The reduction of blood pressure may reduce the blood flow to the central nervous system, which results in the Diginess. Lightheadedness, even fainting, can be observed. So central side effects like diziness and lightheadedness is commonly observed with all the CCBs which produce the hypotension. That’s why these drugs can produce some drowsiness and sleepiness in the patients. And these drugs should be carefully combined with other vasodilators in order to avoid significant hypotension.
Fourth one is the edema. Particularly, dihydropidines directly act on the vascular muhmazil so they can produce direct vasodilation. Because of direct vasodilation, the capillary permeability is going to be increased, which results in the accumulation of fluids leading to peripheral edema. So dihydropadins can produce some ankle swelling and lower limb edema. Because of their direct action on vascular smooth muscle.
Verap mill does not produce significant edema, just like dihydropadines, because this drug is not directly acting on the vascular smooth muscle. On the other hand, diltiam can act on vascular smooth muscle, so this drug can also increase the ankle swelling and peripheral edema. Fifth one is the flushing. Again, this side effect is observed with all the CCBs which produce vasodilation and hypertension. These drugs particularly produce cutaneous vasodilation, which results in the increased blood flow leading to facial redness and redness of the skin.
This may also result in the decreased pooling of blood at the skeletal muscle, resulting in some fatigue. So flushing and fatigue are the two important side effects produced by all the CCBs. 6th one is the gingival hyperplasia. Again. CCBs particularly dihydropidins and diltiazm can produce gingival hyperplasia.
These drugs can reduce the synthesis of aldosterone in the adrenal cortex. Because calcium is required in the synthesis of aldosterone. CCBs can block the synthesis of aldosterone which is calcium dependent, and when these autosterone levels are reduced, it can produce some negative feedback mechanism, resulting in the increased production of ACTH from the anterior pituitary. When the ACTH levels are increased, it results in the increased synths of testosterone. So this testosterone may result in the proliferation of the gums, resulting in gingival hyperplasia.
Particularly, this side effect is observed with chronic use of calcium channel blockers with the Verap mill. After one year of treatment, proliferation of gums can be absurd. 7th one is the hypotension. This is a common side effect of all these drugs because these drugs are acting like antihypertensive. So all these drugs can produce hypertension, but they act in different way, whereap milk can act on the heart, thereby can reduce the rate of contraction as well as force of contraction.
And when both rate as well as force of contraction are reduced, it results in the decreased cardiac output. So this results in decreased pumping pressure leading to hypotension. So verapnel is producing the hypotension by acting on the heart. It is not directly acting on the vascular smooth muscle, but the dihidopidins like nipidipin, can directly act on the VASCAR smooth muscle, thereby they can produce direct vasodilation, again resulting in hypotension. So even they act in different way.
