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Editor s: Ahaana Singh, Lisa Miklush, PhD, RN, CNS. Can be up to 850 units/hr of insulin!!! Dabush-Elisha I,Goren O,Herscovici A,Matot I, Bradycardia During Laparoscopic Surgeries: A Retrospective Cohort Study. Common drug interactions for calcium channel blockers can occur with any other blood pressure medications, heart medications, certain eye medications, corticosteroids, and high doses of Vitamin D or calcium. This leads rapid opening of fast sodium channels and a slower opening of L-type calcium channels that permit calcium to enter the cell (phase 0 and 2, respectively). Felodipine is an agent in the dihydropyridine class of calcium channel blockers. Presse medicale (Paris, France : 1983). There have also been reports of gingival hyperplasia. Excretion: Calcium channel antagonists are primarily excreted renally after metabolism. Calcium Channel Blockers - Indications and Contraindications. Of these, 10 are major, over 600 are moderate, and 58 are minor. Calcium channel blockers are a class of prescription drugs. The 'Gold Standard' textbook in dentistry today, MEDICAL EMERGENCIES IN THE DENTAL OFFICE prepares dental professionals for recognizing and managing medical emergencies and diminishing their danger. They work by blocking the tiny channels that allow calcium to enter the cells. More detailed discussions of the use of CCBs in specific arrhythmias, CCBs for non-arrhythmic conditions, and other treatment options for arrhythmias are presented separately. They … Absorption: Calcium channel antagonists are absorbed well orally, however many have low bioavailability due to hepatic first-pass metabolism, primarily by CYP3A4. Calcium channel antagonists, also known as calcium channel blockers (CCBs), have been widely used for many indications. Diltiazem, however, can be called a few things. Common indications include angina pectoris, essential hypertension, and arrhythmias. Found insideComprehensive and authoritative, Hypertension in the Elderly offers family practitioners and general internists an up-to-date, user-friendly reference on the diagnosis, treatment, and complications of hypertension in the elderly. Grapefruit juice interacts with many medications, including calcium channel blockers, and should be avoided. Calcium channel blockers are available in short-acting and long-acting forms. prevents tissue infarction by inhibiting cell necrosis. Cardiovascular indications include hypertension, coronary spasm, angina pectoris, supraventricular dysrhythmias, hypertrophic cardiomyopathy, and pulmonary hypertension. Here is a list of the CCBs you should know: Notice after the first two listed, all the other names end in -dipine. In addition to high blood pressure, doctors prescribe calcium channel blockers to prevent, treat or improve symptoms in a variety of conditions, such as: Coronary artery disease Chest pain (angina) Irregular heartbeats (arrhythmia) Some circulatory conditions, such as Raynaud's disease Designed by Elegant Themes | Powered by What Is the Cambridge English: Advanced Test? Amlodipine Sandoz belongs to a group of medicines called calcium channel blockers or calcium ion antagonists. {{courseNav.course.topics.length}} chapters | Distribution: Calcium channel antagonists are highly protein-bound, and many have high volumes of distribution. Digoxin also binds to the same calcium channels that CCBs do, except that CCBs have a stronger affinity, kicking digoxin off the binding site and causing potentially lethal serum digoxin levels. For people with hypertension alone, amlodipine may be preferred on the basis of cost. Calcium Channel Blockers Drug Interactions, Create an account to start this course today. These channels are responsible for regulating the influx of calcium into muscle cells, which in turn Calcium channel blockers include: nisoldipine, amlodipine, isradipine, and clevidipine. Administer activated charcoal if the patient has presented early and is awake, alert, oriented, and protecting their airway. Calcium chloride 10% (10 ml for 0.1 to 0.2 ml/kg) or calcium gluconate 10% (20 to 30 ml 0.3 to 0.4 ml/kg) may be administered intravenously and may be repeated every 5 to 10 minutes. These findings are due to peripheral vasodilatation and reduced cardiac contractility. When giving a Calcium Channel Blocker you should monitor heart rate, blood pressure, and digoxin levels. Calcium channel blockers are a class of prescription drugs that are used to treat hypertension, coronary artery disease, and angina. CCBs are particularly effective against large vessel stiffness, one of the common causes of elevated systolic blood pressure in elderly patients. Always ask yourself these 5 questions when you see a drug name to help you understand how the drug works, your role as a nurse, and what information will be asked on an exam about the drug: Name (specifically the family name)? Calcium channel blockers should be taken with food or milk. mechanism of action right and there's. This class of CCBs is most selective for smooth muscle (meaning going to decrease systemic vascular resistance) and used primarily for hypertension. C. Dilates bronchioles. If you are taking large amounts of Vitamin D or calcium supplements this may alter how effective your medication will be. To unlock this lesson you must be a Study.com Member. It is important to review all of your medications with your physician and pharmacist when starting a new medication. Amlodipine, nifedipine, and verapamil are all calcium channel blocker medications. Create your account. Also, do not give with grapefruit juice. © copyright 2003-2021 Study.com. Calcium channel blockers are a class of prescription medications that are used to treat hypertension or high blood pressure, coronary artery disease, and angina or chest pain. Calcium Channel Blockers 1. Calcium channel blockers are medications that help decrease blood pressure, prevent angina (variant), and treat dysrhythmias. They often classify into two major categories, either non-dihydropyridines or dihydropyridines. These drugs as a group have many potential clinical indications, especially in diseases in which vascular or smooth muscle spasm seems to cause the disease. Calcium Channel Blockers: Key side-effects in 90 seconds Why We Get Sick - Interview with Dr. Ben Page 5/38. Follow the label directions on how often to take it. Describe the adverse effects and contraindications for both classes of calcium channel blockers. If the patient has AV block or sick sinus syndrome, do not give this medication. These agents are often classified into two major categories, either non-dihydropyridines or dihydropyridines. Vasodilation will increase edema because it makes the capillaries leaky, making the surrounding tissues fill up with fluid. The non-dihydropyridines include verapamil, a phenylalkylamine, and diltiazem, a benzothiazepine. They are also classified as Type IV antiarrhythmics and work to slow AV conduction. Drugs that can exacerbate heart failure should be avoided, such as nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (CCBs), and most antiarrhythmic drugs (except class III). Nifedipine (Dihydropyridine): Used to treat angina. dihydropyridine calcium channel blockers. This topic will review the electrophysiological properties of calcium channel blockers and their clinical indications in a variety of arrhythmias. Found insideThoroughly updated with current regulations, references to the latest pharmacological data, and new medicinal products, this edition is a comprehensive resource covering latest knowledge and findings related to drugs during lactation and ... Works by vasodilating and decreasing the force of the heart. Hypertension. Calcium channel antagonists block the inward movement of calcium by binding to the L-type “long-acting” voltage-gated calcium channels in the heart, vascular smooth muscle, and pancreas. Heart, lung     [PubMed PMID: 29526418]. Also used to treat angina. 2018 Nov;     [PubMed PMID: 30508892], Pavasini R,Camici PG,Crea F,Danchin N,Fox K,Manolis AJ,Marzilli M,Rosano GMC,Lopez-Sendon JL,Pinto F,Balla C,Ferrari R, Anti-anginal drugs: Systematic review and clinical implications. Oh and guess what else smooth muscle controls? Ca2+ channel blockers are drugs of choice for patients with Prinzmetal's angina and should be first-line drugs for mixed angina, and can be used alone or with beta blockers for classic angina. Found insideHow do you keep track of basic information on the proteins you work with? Where do you find details of their physicochemical properties, sequence information, gene organization? Works by decreasing the force of contraction in the heart (not by vasodilating). Answer: If they have high blood pressure or a fast heart rate, you would administer a CCB. Any time you take more than one medication, you are at risk for having drug interactions. Indications. This review will discuss the mechanism of action of calcium channel blockers, what conditions they treat, nursing … Other contraindications include sick sinus syndrome (except in patients with an artificial pacemaker), severe hypotension, acute myocardial infarction, and pulmonary congestion. This also improves blood flow to the heart muscle. It is essential to review all medications that you take with your physician and pharmacist when starting a calcium channel blocker. HTN: Initially 2.5-5 mg once daily. Diabetes and hypertension have evolved as two of the modern day epidemics affecting millions of people around the world. Diuretics: function. Hyperglycemia has been considered a prognostic indicator of the severity of calcium channel antagonist toxicity. Verapamil or Cardizem overdose) and magnesium sulfate overdose. Tech and Engineering - Questions & Answers, Health and Medicine - Questions & Answers, Which of these drugs has been developed through the use of structure-activity relationships: a. Aspirin b. Gentamicin c. Erythromycin A d. Atorvastatin, Select the correct answer. Calcium channels are found in abundance at the SA and AV nodes as well as in cardiac myocytes, and smooth muscle cells. … 2018 Dec 4;     [PubMed PMID: 30538056], Hernandorena I,Bailly H,Piccoli M,Beunardeau M,Cohen A,Hanon O, [Hypertension in the elderly]. They increase cardiac output by inhibiting the breakdown of cAMP. Reproductive System Functions and Anatomy, TExES Principal Exam Redesign (068 vs. 268), Addressing Cultural Diversity in Distance Learning, The House of the Seven Gables: Themes & Analysis, Animal Lesson for Kids: Definition & Characteristics, Polar Coordinates: Definition, Equation & Examples, A Newspaper Story by O. 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Verapamil and diltiazem are the most widely used calcium channel blockers. Felodipine is FDA approved and indicated in the treatment of essential hypertension. If you take simvastatin with amlodipine, it is a major drug interaction as it could increase the levels of simvastatin. Yeah you read that right. Smooth muscle cells found around blood vessels control vasodilation and constriction. Consider activated charcoal if very early in process and the patient is asymptomatic. Calcium channel blockers (CCBs) can be divided into dihydropyridines and nondihydropyridines. two different types of calcium channel. Found inside"EACPR, European Association for Cardiovascular Prevention and Rehabilitation -- European Society of Cardiology." This will inherently increase the refractory period of the AV node (increasing the PR interval) and decreasing ventricular response. Make sure you have obtained an EKG before administering a CCB to someone who has never had this medication. Sexual dysfunction, overgrowth of gums, and liver dysfunction also have been associated with calcium channel blockers. Cardiovascular indications include hypertension, coronary spasm, angina pectoris, supraventricular dysrhythmias, hypertrophic cardiomyopathy, and pulmonary hypertension. When a woman goes into labor at 37 weeks or earlier, it’s … Dosage. Non-dihydropyridines are contraindicated in those with heart failure with reduced ejection fraction, second or third-degree AV blockade, and sick sinus syndrome because of the possibility of causing bradycardia and worsening cardiac output. Calcium channel antagonists, also known as calcium channel blockers (CCBs), have been widely used for many indications. Several calcium channel blockers are available. It has been used since 1962 in Europe then in Japan for its anti- arrhythmic and coronary vasodilator effects/ The CCB have become prominant cardiovascular drugs during the last 15 ),ears. Beta blockers are a group of drugs that inhibit the sympathetic activation of β-adrenergic receptors. Dihydropyridine calcium-channel blockers. Identify the mechanism of action of both categories of calcium channel blockers. Calcium channel antagonists, also known as calcium channel blockers (CCBs), have been widely used for many indications. It is taken by mouth and has an effect that lasts for at least a day. These two medications are different than other calcium channel blockers because they have direct action on cardiac tissue at therapeutic levels. Calcium channel antagonists, also known as calcium channel blockers (CCBs), have been widely used for many indications. If you are taking the calcium channel blocker, Verapamil, there are over 700 identified drug interactions. Supraventricular tachyarrhythmias: atrial fibrillation, AVNRT. So if the kidneys are not working, the CCBs will stay in the blood and body. Of these, 123 are major, 530 moderate, and 49 minor. Beta-blockers, as a class of drugs, are primarily used to treat cardiovascular diseases and other conditions. They differ not only in their basic chemical structure, but also in their relative selectivity toward cardiac versus vascular L-type calcium channels. Calcium Channel Blocker Uses and Indications. Amlodipine is also used to treat high blood pressure (hypertension). In addition, class 1-C drugs are very valuable in the life-threatening supraventricular tachyarrhythmias (flecainide and … Metabolism: In repeated doses, or overdose, the hepatic enzymes responsible for metabolism become saturated and reduce first-pass effects, which therefore increases absorption of the active drug. Amlodipine is another calcium channel blocker that has nearly 600 listed drug interactions. Asprin. Calcium channel blockers (CCBs) are indicated for a variety of cardiovascular conditions and are categorized into three subclasses. Increased effect of calcium channel blockers may lead to hypotension, edema, decreased HR, and acute kidney injury due to reduced renal blood flow; consider initiating nifedipine at the lowest dose available if given concomitantly with this medication. Calcium-channel blockers are widely used as an effective treatment for hypertension and angina. Patients may present asymptomatic initially and progress rapidly to severe hypoperfusion and cardiovascular collapse. Smooth muscles relaxing causing dilation. Political Parties After the Civil War, Quiz & Worksheet - Forms of Evolutionary Change, Bias in Polls & Surveys: Definition, Common Sources & Examples, Resources & Education for Content-Based Instruction, Alternative Teacher Certification in Maryland. In normal hearts, calcium's positive inotropic and vaso-constricting effects produce a predictable rise in systemic areterial pressure. The purkinje fibers will take over as the pacemaker at this time so the heart rate will be slowwwww (20-40 bpm). So these patients can have constipation. Examples of calcium channel blockers include:Amlodipine (Norvasc)Diltiazem (Cardizem, Tiazac, others)FelodipineIsradipineNicardipineNifedipine (Adalat CC, Procardia)Nisoldipine (Sular)Verapamil (Calan, Verelan) Consider starting treatment at a lower dose. So the list you really need to remember is: In my practice, I have only ever called Verapamil by its name, Verapamil. Calcium-channel blockers potentiate ACE inhibitor effects. Calcium channel antagonists, also known as calcium channel blockers (CCBs), have been widely used for many indications. Calcium chloride injection is also used in cardiac resuscitation, arrhythmias, hypermagnesemia, calcium channel blocker overdose, and beta-blocker overdose. Calcium-channel blockers (sometimes called calcium antagonists) are a group of medicines that affect the way calcium passes into certain muscle cells. They are used to treat various conditions, including high blood pressure, angina, Raynaud's phenomenon and some abnormal heart rhythms (arrhythmias). Not only do you want to tell them about your prescription medications, but all over the counter medications, herbal or natural remedies, and vitamins and supplements that you are taking. If side effects do occur, the patient's treatment depends on symptoms. coronary vasodilation. Check out our other Matters of the Heart post in our series! Dihydropyridine calcium channel blockers are available in fixed-dose combinations with beta-blocker or angiotensin receptor blocker; verapamil is available in combination with an ACE inhibitor. An up-to-date reference on this fascinating set of complex disorders, this book features the most comprehensive strategies for diagnosing, classifying, imaging, treating, and managing amyloidosis in multiple organ systems. Only one class, the dihydropyridines, includes more than one commercially available drug. Guidelines stipulate that a non-dihydropyridine calcium channel blocker may be prescribed in certain patients, often with co-morbid indications. Found insideThe third edition of Hypertension: A Companion to Braunwald's Heart Disease, by Drs. George L. Bakris and Matthew Sorrentino, focuses on every aspect of managing and treating patients who suffer from hypertensive disorders. Verapamil (Covera- HS, Verelan PM, Calan) and diltiazem ( Cardizem LA, Tiazac) worsen heart failure because they reduce the ability of the heart to contract and pump blood. Amlodipine is a calcium channel blocker that dilates (widens) blood vessels and improves blood flow. Before starting a calcium channel blocker, you need to be aware of possible drug interactions. Blocks L-type (slow) calcium channels, which decreases myocardial contraction force. Presenting the latest diagnostic and therapeutic developments in a multifaceted field, this book addresses the problems involved in preventing sudden cardiac death (SCD), focusing on risk stratification techniques designed to direct the ... acts on the distal tubule to decrease reabsorption of Na. So you give CCBs for tachycardia and/or hypertension. 1. Short-acting medications work quickly, but their effects last only a few hours. SVT Supra-ventricular tachycardia. For LERCANIDIPINE HYDROCHLORIDE. So if symptoms start to occur, they will continue to get worse because there is more of the medication to be released. Calcium channel blockers stop too much calcium from entering the heart cells. The same is true for calcium channel blockers and nitrates, due to their anti-ischemic effect. Verapamil: Vasodilator given with a beta blocker to prevent tachycardia, as well as with a diuretic to prevent sodium and water retention. There are 16 major, over 500 moderate, and 64 minor interactions identified. Calcium Channel Blockers: Indications. terminology calcium entry blockers and a more appropriate one: calcium channel blockers (CCBs), when their binding to voltage-operated Ca channels had been demonstrated to be responsible for their pharmacological effects.11,13,14 1Universite Catholique de Louvain, Brussels, Belgium Manuscript submitted: January 10, 2014; accepted: March 11, 2014. These agents are often classified into two major categories, either non-dihydropyridines or dihydropyridines. thing that we have to talk about with. Found insideAnesthesiology. Residents who are unable to pass the Basic examination will not be allowed to finish their training. That's why this book is a true must read for every anesthesiology resident. If it is an extended release (ER) than it can be up to 4 hours after ingestion of the CCB. Hydrochlorothiazide acts on the distal convoluted tubules and inhibits the sodium chloride co-transporter system. Take vital signs prior to administering this medication. cardiac chest pain. This cardiovascular drug class is one of the leading causes of drug-related fatalities. Found inside – Page 1Building on the success of the 14 previous editions, this remarkable reference has been extensively reorganized and expanded and now comprises almost 1,500 individual drug articles providing the most complete coverage of adverse reactions ... Patients unresponsive to thiazides should try adding an ACE inhibitor (or more expensive ARB), beta blocker or calcium channel blocker, sequentially (unless there are specific contraindications or indications influencing the choice of drug therapy, such … I am going to just leave my personal thought process I have for memorizing the CCB list below in a picture: There are three types of Calcium Channel Blockers (CCBs). what are the names of those two drugs. The Calcium Channel Blockers Blood Test helps determine the levels of CCBs in blood. When calcium is slowed from crossing into the SA or AV node cells, electrical activity will slow down, decreasing the rate of impulses being sent out to contract the heart. Calcium channel blockers are drugs used to lower blood pressure.They work by slowing the movement of calcium into the cells of the heart and blood vessel walls, which makes it … bronchospasm. It is used when adjusting the initial dose, and to ensure that CCB levels stay within an acceptable range; What are the Clinical Indications for performing the Calcium Channel Blockers … Patients who received Nimodipine in clinical trials for other indications reported flushing (2.1%), headache (4.1%) and fluid retention (0.3%), typical responses to calcium channel blockers. Cardiovascular indications include hypertension, coronary spasm, angina pectoris, supraventricular dysrhythmias, hypertrophic cardiomyopathy, and pulmonary hypertension. From vasodilation, increase in blood flow can cause headaches (like with nitroglycerin!). When the blood vessels relax, they widen and result in decreased blood pressure. Atropine is a reasonable initial treatment option, but it typically does not reverse the effects of calcium channel antagonist poisoning. hydrochlorothiazide indications. Obtain a chest X-ray and basic labs (including acetaminophen and salicylate levels if warranted). Symptoms may include lightheadedness, fatigue, change in mentation, syncope, coma, and sudden death. Establishes the medication calcium channel blockers (CCBs), for example, amlodipine (Norvasc) and combinations of amlodipine, vidipine (Cleviprex), diltiazem (Cardizem), felodipine (Plendil), nifedipine (Procardia, nimodipine (Nimotop), nisoldipine (Sular), and verapamil (Calan). Monitor for toxicities of dihydropyridine CCB if diltiazem are initiated/dose increased, or decreased effects if diltiazem are discontinued/dose decreased. Net effect= Decreases myocardial oxygen requirement. Below I listed them for classification purposes: When a CCB is distributed into the bloodstream and flows to the heart, it attaches to the calcium channels. Cardiac conduction may also suffer impairment with AV conduction abnormalities, complete heart block, and idioventricular rhythms. Manufacturer advises avoid in severe impairment. Slowing conduction through the SA and AV nodes. Since 1995, in addition to the long established suggestion that monotherapy with short-acting calcium channel blockers (CCB) worsens outcomes in coronary disease 1-6, reports have suggested haemorrhage 7-9, increased incidence of cancer 10,11 and poor cardiovascular outcomes in diabetes 12,13 are potential adverse effects of this drug class. While not typically recommended in heart failure, amlodipine may be used if other medications are not sufficient for treating high blood pressure or heart-related chest pain. This site uses Akismet to reduce spam. Reduction in blood pressure lowers the risk of cardiovascular morbidity and mortality. Vasodilator that is the least selective of the calcium channel blockers, affecting both vascular and heart calcium channels. are a class of medications that are predominantly used to manage abnormal heart rhythms, and to protect the heart from a second heart attack (myocardial infarction) after a first heart attack (secondary prevention). They are most commonly used today as a first-line treatment for hypertension , but they are also effective in treating angina , supraventricular tachycardia , and hypertrophic cardiomyopathy . ... v-fib/v-tach. Common blockers of L-type calcium channels are 1,4-dihydropyridines, which are used in treatment of cardiovascular diseases. Cardiovascular indications include hypertension, coronary spasm, angina pectoris, supraventricular dysrhythmias, hypertrophic cardiomyopathy, and pulmonary hypertension. If the patient is refractory to these interventions, initiate vasopressor therapy using intravenous norepinephrine or push-dose phenylephrine while preparing hyperinsulinemia/euglycemia (HIE) therapy. Clopidogril (Plavix) Cardiac Chest Pain. If you are taking any other medications for the heart such as digitalis, blood pressure medications, or diuretics (water pills), this can cause a drug interaction with calcium channel blockers. Home; ... For all CALCIUM-CHANNEL BLOCKERS. Terms in this set (61) Adensoine. They may also be … ( 7.2) Drugs that may cause hypercalcemia: Vitamin D, vitamin A, thiazide diuretics, estrogen, calcipotriene and teriparatide administration may cause hypercalcemia. dizziness. Albuterol. Monitor plasma calcium concentrations in patients taking these drugs concurrently. Makes sense right? Through nine outstanding editions, Rutherford's Vascular Surgery and Endovascular Therapy has been the gold standard text in this fast-changing, complex field. This practical book provides a concise tutorial of all the essential aspects of cardiovascular hemodynamics and the techniques used to assess cardiovascular performance. This will tell you WHY the drug was ordered…what condition is this medication treating in your patient? Calcium channel blockers are typically administered in oral dosage forms, but orally administered calcium channel blockers undergo significant first-pass metabolism in the gut and liver, which can significantly reduce bioavailability to 10–30%. Calcium channel antagonists, also known as calcium channel blockers (CCBs), have been widely used for many indications. Although CCBs … Calcium channel blockers are widely used in the treatment of hypertension, angina pectoris, cardiac arrhythmias, and other disorders. Calcium channel blockers (CCBs) are indicated for a variety of cardiovascular conditions and are categorized into three subclasses. | {{course.flashcardSetCount}} Different Classes of Calcium-Channel Blockers. Ca 2+ channel blockers are drugs of choice for patients with Prinzmetal’s angina and should be first-line drugs for mixed angina, and can be used alone or with beta blockers for classic angina. Self-study modules on cardiovascular disease. This continuing Pharmacy Education programme has been developed and produced by GenRx Pty Ltd in conjunction with the Pharmaceutical Society of Australia. These preparations may improve compliance, and should be considered, provided there is no cost disadvantage. Classified into two major categories, either non-dihydropyridines or dihydropyridines is an indication of efficacy of choice Acute... Nifedipine ( or Procardia ) works by: A. decreasing myocardial demand through slowing rate... Responsible for regulating the influx of calcium ions is essential to review all of your medications with your physician pharmacist... Associated with calcium channel blocker may be prescribed in certain patients, often with co-morbid.... To 3 weeks of initiating calcium channel antagonists, also known as calcium channel antagonists are classified. 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In vasodilatory shock, may be preferred on the proteins you work with,. Uses and indications … calcium channel antagonists are highly protein-bound, and certain heart rhythm disorders to pump around! Vasodilating ) responsible physician 's judgment remains paramount, Goren O, Herscovici,... Work quickly, but these agents are often classified into two major categories, either non-dihydropyridines dihydropyridines. Patients who are unable to pass the basic examination will not be administering oral CCBs in an emergency you... Demand and reversing coronary vasospasms amlodipine overdose resulting in lower blood pressure in patients with hypotension calcium channel blockers indications bradycardia should to... Love the outdoors, fishing, and should be given with caution in patients these. The smooth muscle, opening up the blood and body absorbed well orally, however many have high volumes distribution... 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