Question

Which one of the following calcium channel blockers used as anti-anginal agents has the highest possibility to produce a negative inotropic effect, AV nodal block, bradycardia, decreased cardiac output, constipation, edema and is contra-indicated in sick sinus syndrome?

• A. Nifedipine
• B. Amlodipine
• C. Diltiazem
• D. Verapamil

Answer 1

The Correct Option is D

The question asks which calcium channel blocker used as an anti-anginal agent has the highest likelihood of causing a negative inotropic effect, AV nodal block, bradycardia, decreased cardiac output, constipation, edema, and is contra-indicated in sick sinus syndrome.

Let's explore each of the given options:

• Nifedipine: Primarily a peripheral vasodilator, nifedipine is less likely to affect cardiac conduction or contractility. It's more associated with peripheral side effects like reflex tachycardia.
• Amlodipine: Similar to nifedipine, amlodipine is also more focused on peripheral vasodilation and less likely to significantly impact the heart's conduction or force of contraction.
• Diltiazem: While diltiazem does have some cardiac effects, including slowing down conduction through the AV node, it is generally less potent in causing negative inotropic effects compared to verapamil.
• Verapamil: Primarily affects the heart by decreasing contractility (negative inotropic effect), slowing AV node conduction (possibly leading to AV nodal block), and causing bradycardia. It can decrease cardiac output and is known for these cardiac-related side effects. Verapamil can also cause constipation and peripheral edema.

Conclusion: Verapamil is known for its potent cardiac action, making it most likely among the given options to produce the listed effects and is contraindicated in sick sinus syndrome due to its potential to worsen bradycardia and conduction defects.

Therefore, the correct answer is Verapamil.