Which of the following calcium channel blockers is used to counteract or prevent cerebral vasospasm?
A. verapamil
B. nimodipine
C. nifedipine
D. felodipine
Correct Answer: B. nimodipine
Nimodipine is given in the neurologic client to prevent cerebral vasospasm. Nimodipine should be given to patients with no neurological deficits after subarachnoid hemorrhage to reduce the onset of new neurological deficits due to vasospasm. (Cerebral arterial spasm controlled trial of nimodipine in patients with subarachnoid hemorrhage, 1983). Verapamil, nifedipine, and felodipine are given in cardiac disease and in the management of hypertension only.
Option A: Verapamil is a non-dihydropyridine calcium channel blocker. Calcium channel blockers inhibit the entry of calcium ions into the slow L-type calcium channels in the myocardium and vascular smooth muscle during depolarization. This inhibition will produce relaxation of coronary vascular smooth muscle as well as coronary vasodilation, which is helpful in patients with hypertension.
Option C: Nifedipine reduced the frequency of angina and increased the mean exercise time in the IMAGE trial. Reflex tachycardia may limit its effectiveness; the addition of a beta-blocker can overcome this limitation.
Option D: Felodipine is an agent in the dihydropyridine class of calcium channel blockers. Felodipine is FDA approved and indicated in the treatment of essential hypertension. Reduction in blood pressure lowers the risk of cardiovascular morbidity and mortality. The most significant benefit of the antihypertensive effect of felodipine is a decrease in the incidence of stroke.