Anti-Anginal Drugs

Front 1

What are the nitrate drugs?

Back 1

Isosorbide dinitrate
Isosorbide mononitrate
Nitroglyceride
Sodium Nitroprusside

Front 2

MOA of nitrates?

Back 2

Nitrates mimic the action of NO. endothelial cells make NO. NO activates Guanylyl cyclase which converts cGTP to cGMP. cGMP inhibits Ca entry into cell --> causes vessel SM relaxation, inhibit platelet aggregation (anti-thrombotic) and anti-inflam
cGMP also activates K channels which causes hyperdepol --> SM relaxation
NO--> venodilation--> dec preload
NO--> vasodilation--> dec afterload (dec O2 demand) thus releave variant angina.

Front 3

Adverse effects of Nitrates?

Back 3

Tolerance may be induced with chronic use (need to have 10-12 hours of "nitrate-free interval"
Headache, reflex tachy, hypotension, facial flushing
Sodium nitroprusside-->cyanide toxicity (thus tx w/sodium thiosulfate)

Front 4

Sildenafil?

Back 4

If you take sildenafil with nitrates, it will inh breakdown of cGMP and increase the affects of nitrates

Front 5

Clinical use of nitrates?

Back 5

variant angina, stable and unstable angina

Front 6

clinical use of nitroglycerin?

Back 6

first line of tx for acute anginal symp

Front 7

clinical use of isosorbide mononitrate/dinitrate?

Back 7

prophylaxis for angina

Front 8

clinical use of sodium nitroprusside?

Back 8

very fast acting -->used for ICU or Emergency

Front 9

beta-blockers as angina treatment --> what are their clinical use?

Back 9

dec HR, contractility, O2 demand (decrease the frequency/severity of anginal attack)

Front 10

Contraindications of Beta-blockers as anti-anginal drugs?

Back 10

pt's with variant angina (only use Ca blocker or nitrates)
never discontinue abruptly
COPD pt

Front 11

Which drugs combined with beta-blockers they relieve variant angina?

Back 11

Ca channel blockers:
Felodipine (dihydropyridine)
Amlopidine (dihydropyridine)

Front 12

MOA of Felodipine, Amlopidine?

Back 12

CCbs block L-type Ca channels on vascular SM, heart, nodal tissue --> decrease HR, TPR, BP (may evoke reflex tachy)

Front 13

Adverse effects of dihydropyridines?

Back 13

flushing, hypotension, peripheral edema, constipation, headache
if short-acting dihydropyridines used by themselves they will cause inc mortality (thus use with beta-B)

Front 14

Clinical uses of verapamil, diltiazem?

Back 14

HTN, angina, arrhythmia

Front 15

MOA of verapamil, diltiazem

Back 15

Verapamil: slows AVN conduction (dec HR, contractility, BP, O2 demand)
Diltiazem releave variant angina

Front 16

adverse effects of verapamil, diltiazem

Back 16

constipation and can be contraindicated in pt w/previous cardiac pr, AVN conduction pr, pt w/digoxin

Front 17

clinical use of ranolazine?

Back 17

last option for pt who failed all other anti-anginal tx

Front 18

MOA of ranolazine?

Back 18

Na is blocked--> Na/Ca exchanger can't work and Ca decreases inside (recall that in an ischemic heart muscle, the channels are all reversed)

Front 19

Adverse effects of ranolazine?

Back 19

QT interval prolongation
nausea, dizziness, constipation