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31 Cards in this Set
- Front
- Back
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Three drug (categorical) treatments to prevent the recurrence of angina by improving oxygen supply and reducing demand. |
Long-Acting Nitrates B Blockers Ca Channel Blockers |
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Describe the clinical uses of Nitrates |
Termination of Acute Angina, Prophylaxis of Stress Angina, long term prophylaxis against angina, Pt not responsive to B blockers or Ca channel blockers, Tx Cyanide poisoning. |
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Describe the treatment for Cyanide Poisoning. |
Amyl Nitrite followed by Methylene Blue. |
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How does nitrates reduce workload in myocardium. |
Reduce oxygen consumption through reduced work-load: Peripheral venodilation (Pre-load), dilation of arteries reducing BP (after-load) |
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How does Nitrates increase Oxygen supply to Ischemic myocardium? |
Nitrates dilate coronary arteries to redistribute coronary blood flow via collaterals. Opposition to coronary spasm in Prinzmetal angina. |
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How do Nitrates prevent platelet aggregation? |
Modest inhibition of Thromboxane synthetase. |
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What drug do you not give to an angina patient and why? |
Dipyridamole: Dilation of coronary arterioles without dilation of collateral circulation. Further reduction of blood flow to ischemic areas. |
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Signal Transduction of Nitrates |
Increased NO/Nitrates activates GC which converts GTP --> cGMP which leads to dephosphorylation of myosin light chains. Relaxation of vascular smooth muscle. |
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Adverse Effects of Nitrates. |
Flushing, Nausea, Throbbing Headache, Orthostatic HoTN, Reflex Tachycardia, Syncope, Dizziness, Methemoglobinemia in large doses of Nitroglycerine. |
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Tolerane to Nitrates |
Develops after a few days of therapy: reduced headache and HoTN. Tolerance to vasodilatory effects with continued use. More likely with longer lasting nitrates or transdermal patches of nitroglycerine. Prevent by providing nitrate-free interval at night. |
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Contraindications of Nitrates |
Do not use with PDE inhibitors ( - AFIL meds): prevent brakedown of cGMP and prolong nitrate effects. Concurrent use of migraine medication: decrease the effects of nitrates. |
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Pharmacokinetics of Nitrates |
Trinitrate: 90% undergo First-Pass effect Dinitrate: slow onset of action, longer half-life Mononitrate: slower action, longest half-life |
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B Blockers in the treatment of Angina |
Use with Stable angina. Blocking B1 receptors resulting of reduction of myocardial workload and oxygen demand. Prevents increased HR and contractility induced by exertion. |
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Side effects of B Blockers |
Bradycardia, Bronchospasms, fatigue, depression, rebound HTN if stopped abruptly. |
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Dihydropyridine Ca Channel Blockers |
Nifedipine Bepiridil Preferentially blocks VASCULAR L-type channels |
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Phenylalkylamines Ca Channel Blockers |
Verapamil Block CARDIAC L-type channels |
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Benzothiazepines Ca Channel Blockers |
Diltiazem Blocks CARDIAC and VASCULAR L-type channels |
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Therapeutic effects of Ca Channel Blockers in Stable Angina |
Prophylactic in sable angina, Combines with nitrates, blocks Ca influx during depolarization to decrease HR and contractility, vasodilation. Increases oxygen supply by dilating coronary arteries to increase perfusion and reverse vasospasm. |
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Other use of Ca Channel Blockers |
PSVT, Migraine, Reynaud, Stroke. |
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Nifedepine in Angina |
Venodilation - Preload reduction Reduces TPR - Afterload Reduction relieving coronary vasospasm |
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Adverse Effects of Nifedepine |
Headache, Flushing, Ankle Edema, HoTN, Reflex tachycardia, constipation, gingival hyperplasia. |
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Bepiridil effects and side effects |
Blocks Na and Ca channels. Used in Chronic Stable Angina (not first line). Side effects: heart failure if combines with b Blockers, torsades, arrhythmia, agranulocytosis. |
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Verapamil Therapeutic actions |
Used in Stable and Variant Angina Decreases cardiac workload and oxygen demand through dec HR, slowing conduction through AV node, and decreased contractility |
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Side effects of Verapamil |
Constipation and Gingival Hyperplasia, Sinus bradycardia, myocardial depression, HF, edema, headache DO NOT COMBINE WITH B BLOCKERS! AV block |
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Diltiazem: Clinical Uses |
Stable and variant angina. Decreases cardiac workload and contractility with decreased preload through venodilation. |
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Side effects of Diltiazem |
Sinus Bradycardia, AV block, Heart failure, hypotension and edema. |
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Ranolazine |
Tx of chronic stable angina Not used for first line tx. known to prolong QT interval. Use with amlodipine, b blocker, or nitrate. Blocks Late Na current. SE: Constipation, nausea, asthenia, dizziness. |
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Ranolazine drug interactions |
CYP3A and CYP2D6 metabolism. Clarithromycin can prolong the half life. Do not use with other QT prolongation drugs. |
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Treatment goals of Variant Angina |
Relieve chest pain while minimizing myocardial damage. Nitrates, Ca channel blockers. B blockers are not effective. |
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Treatment goals of Acute Coronary Syndrom |
Relieve chest pain to prevent irreversible injury. Manage oxygen demand through b blockers and nitrates. Opioids to reduce pain and prevent sympathetic activation. anticoag, antiplt. Evaluate STEMI |
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Therapeutic management post ACS |
Antiplt, antiarrhythmics lifesytle modifications, ACE inhbitors, B Blockers, Antiplt, Statins |
