Anti-Anginal Drugs

Front 1

Nitrates & Nitrites

Back 1

Amyl Nitrite

Nitroglycerin

Isosorbide Mononitrate

Front 2

B-Blockers

Back 2

Propranolol

Atenolol

Metoprolol

Front 3

Ca Channel Blockers

Back 3

Selective:
Nifedipine
Nicardipine

Non-Selective:
Verapamil
Diltiazem

Front 4

MoA of Nitrates

Back 4

Increase NO activates cytosolic form of guanylyl-cyclase --> increase in cGMP --> activation of protein kinase G --> decrease in intracellular CA = vasodilation of large veins (capacitance vessels) which results in decreased preload and cardiac output, increased perfusion of subendocardial regions; after higher doses - reflex tachycardia, postural hypotension; decreased platelet aggregation, increased methemoglobin formation (decreases O2 carrying capacity of blood)

Front 5

Tolerance & Dependence of Nitrates

Back 5

Tolerance to a nitrate results in tolerance to all other compounds of the class; tolerance appears rapidly (24 hours) and disappears rapidly (6-10 hours) so transdermal patch must be taken off overnight to permit tolerance recovery; cannot be abruptly withdrawn!!

Front 6

AE of Nitrates

Back 6

Throbbing headache; CV system: flushing of the face, palpitations, postural hypotension

Front 7

CI of Nitrates

Back 7

Hypertrophic cardiomyopathy, constrictive pericarditis; increased cerebral pressure; severe hypotension, hypovolemic states; hyperthyroidism

Front 8

Therapeutic Uses of Nitrates

Back 8

Tx or prevention of acute angina attack (N-sublingual route or AN-inhalant ), chronic prophylaxis of angina (N-oral or transdermal); systolic heart failure, MI with impending heart failure or HTN (N-IV); cyanide poisoning

Front 9

MoA of B-Blockers

Back 9

Decrease cardiac O2 demand by reducing heart rate, cardiac contractility, and lowering blood pressure; increase cardiac perfusion due to increase diastole duration; also reduce myocardial remodeling, decrease risk of vFib, and limit infarct size;
do not abruptly withdraw!!!

Front 10

Therapeutic Uses of B-Blockers

Back 10

Chronic prophylaxis of exertional angina, acute treatment of unstable angina; NOT EFFECTIVE in VARIANT angina (b/c of vasoconstrictive effects)

Front 11

MoA of Ca Channel Blockers

Back 11

Nifedipine & Nicardipine - block L-type voltage gated Ca channels in the vessels only;
Verapamil & Diltiazem - block L-type voltage gated Ca channels in the heart and vessels; also decrease conduction in slow fibers, decrease automaticity, decrease contractility, increase refractoriness; both classes result in arteriolar vasodilation;
Verapamil blocks P170 glycoprotein (multidrug transporter associated with cancer cell drug resistance)

Front 12

Therapeutic Uses of Ca Channel Blockers

Back 12

DOC for exertional angina (V&D) and variant angina (all); unstable angina and MI; cardiac arrhythmias; hypertrophic cardiomyopathy, diastolic heart failure; subarachnoid hemorrhage; Raynaud's phenomenon; migraine; neuropsychiatric disorders

Front 13

AE of Ca Channel Blockers

Back 13

CV: flushing, peripheral edema, profound hypotension, tachycardia, palpitations, AV block, bradycardia, arrhythmias, vFib, aggravation of MI;
constipation

Front 14

CI of Ca Channel Blockers

Back 14

Hypotension; cardiogenic shock, systolic heart failure; WPW, ventricular tachycardia, SA & AV block, sick sinus syndrome; MI (N&N); digoxin overdose (V); constipation

Front 15

Combo Therapy for Angina

Back 15

Nitrates + B-Blockers = exertional angina
Nitrates + Ca Channel Blockers = exertional & vasospastic angina
Nitrates + B-Blockers + Ca Channel Blockers = in patients with exertional angina not controlled by 2 types of anti-anginal drugs