Which correctly ranks calcium channel blockers from most active on the myocardium to most peripherally active?

The correct ranking of calcium channel blockers from most active on the myocardium to most peripherally active can be understood by examining the pharmacological profiles of these drugs.

Verapamil has a significant impact on myocardial tissue due to its strong affinity for cardiac calcium channels, which makes it particularly effective in reducing heart rate and contractility. This property makes verapamil the most cardiotropic calcium channel blocker of the options listed.

Diltiazem also affects the myocardium, though to a slightly lesser extent than verapamil. It has balanced effects on both the cardiac and vascular smooth muscle, making it effective for managing certain heart conditions while also providing peripheral vasodilation.

Nifedipine (often represented by amlodipine, a long-acting derivative) primarily targets vascular smooth muscle. Its main action is to cause peripheral vasodilation, making it the most peripheral acting of the calcium channel blockers in this context.

This order reflects how these medications function in clinical practice, with verapamil being primarily used for its cardiac effects, diltiazem serving a dual role, and nifedipine focusing on vascular smooth muscle to achieve peripheral effects. Thus, the ranking of verapamil, diltiazem, and nif