Anti-Anginal Drugs

Front 1

Angina Pectoris etiology and sx?

Back 1

- inadequate blood flow to myocardium
- could be due to atherosclerosis, vasospasm, or other causes
- causes oxygen / supply demand imbalance
SX.
- crushing feeling of suffocation in chest

Front 2

Angina Pectoris is a primary sx of...

Back 2

Ischemic Heart Disease

Front 3

What are the two types of Angina Pectoris? thier differences?

Back 3

1. CLASSIC (stable, typical, exertional)
- coronary occlusion
- endothelial dysfunc
- evident w/ exercise
- benefit by dec O2 demand
2. VARIANT (angiospastic, vasospastic, Prinzmetals)
- transient, localized coronary art spasm
- @ rest
- benefits by inc O2 supply

Front 4

Unstable Angina etiology and sx?

Back 4

- an acute coronary syndrome
- worsening angina with varying freq & duration occurring @ rest
- can have ruptured plaque & plt aggregation

Front 5

what is a large risk with Unstable Angina?

Back 5

--> can form clot and lead to MI!!!!

Front 6

tx for Unstable Angina?

Back 6

- Aspirin
- Anti-plt (Clopidogrel)
- Anti-coag (Heparin)

*basically want to prevent clot forming or thrombus

Front 7

what is Silent Ischemia? what tx w/?

Back 7

- angina w/ no overt sx
- ischemic burden
- same drugs as angina
(B-blockers>>Ca channel antag for prevention)

Front 8

4 Steps for tx. Angina Pectoris?

Back 8

1. Tx conditions that precipitate angina
(HTN, Anemia, Obesity, HF, Arrhythmias, Anxiety)
2. smoking cessation
3. avoid sympathomimetics
4. Vascular interventions

Front 9

4 GOALS for tx of Angina Pectoris?

Back 9

1. Stop attacks
2. inc exercise tolerance
3. dec O2 demand
4. inc O2 supply

Front 10

drug set to help reduce HR (dec O2 demand)?

Back 10

B-blockers

Front 11

what drug set would you give to dec preload (dec O2 demand)?

Back 11

Nitrates

Front 12

what drug set would you give to reduce afterload (dec O2 demand)?

Back 12

vasodilators (Ca antag)
(Nitrates)

Front 13

what drug set would you give to reduce contractility (dec O2 demand)?

Back 13

B-blockers
Ca antag

Front 14

what drug set would you give to inc coronary artery vasodilation (inc O2 supply)?

Back 14

Nitrates
Ca antag

Front 15

3 Drug groups for Angina Pectoris?

Back 15

1. statins
2. Anti-plt / anti-coag
3. Aspirin

Front 16

what is the most freq drug used for immediate pain relief in angina?

Back 16

Nitroglycerine

Front 17

3 ways to administer Nitroglycerine?

Back 17

1. sublingual
2. slow release (oral, transdermal patch)
3. IV dosing (emergencies only)

Front 18

T/F Nitroglycerine shows preferential dilation of large coronary arteries?

Back 18

T

Front 19

4 reasons why does Nitrogly work to relieve angina?

Back 19

-->dec vasospasm
-->dilate coronary art
-->dec preload/afterload
-->dec plt aggregation

Front 20

how deos Nitrogly help reducde preload?

Back 20

vein dilation dec venous return thus dec intracardiac vol

Front 21

2 benefits of Nitrogly tablets? negative of Nitrogly tablets?

Back 21

Benefit:
very quick onset (minutes)
avoids 1st pass metablism
Negative:
short duration (half hr)

Front 22

Nitrogly complications

Back 22

1. causes low BP which can trigger a Baroceptor response leading to tachy and myocardial contractility
2. Tolerance develops quickly (need 8-12 hours b/w doses)

Front 23

2 Nitrogly acute side effects?

Back 23

1. HA (avoid giving to pts w/ inc intracranial press)
2. Orthostatic Hypotension

Front 24

who should you not give Nitro too? why not?

Back 24

-pts w/ inc cranial press-->causes HA
-old horny men taking PDE-5 inhibitors (Viagra, Cialis, Levitra)--> can cause LIFE THREATENING HYPOTENSION

Front 25

2 other Nitrates beside Nitroglycerin?

Back 25

1. Isosorbide dinitrate
2. Isosorbide 5 mononitrate

Front 26

3 classes of Ca-channel blockers for tx of angina?

Back 26

1. Dihydropyridines
a) Nifedipine
b) Amlodipine
2. Phenylalkylamines (Verapamil)
3. Benzothiazepines (Diltiazem)

Front 27

Nifedipine main benefit / effect? Negative aspect?

Back 27

BENEFIT
- quick onset (5-20min)
- fewer cardio-depressant effects than other Ca-channel blockers (except Amlodipine)
NEGATIVE
- as monotherapy least effective Ca-channel blocker
MAIN EFFECT
- arteriolar vasodilator

Front 28

difference for Amlodipine?

Back 28

- slower absorption w/ prolonged action
- vasodilator of coronary & peripheral art

Front 29

3 adverse effects of Nifedipine?

Back 29

- excessive vasodilation leads to...
1. HYPOtension
2. reflex tachy
3. flushing, HA, peripheral edema

Front 30

Benefit for choosing Amlodipine?

Back 30

- much less SE
- minimal reflex tachy
- NO cardiodepression

Front 31

which Ca-channel blockers have hepatic metabolism? kidney elimination ?

Back 31

-Nifedipine & Diltiazem
-70% of Verapamil eliminated by Kidney

Front 32

Verapamil mechanism?

Back 32

- cardiac depressant
-->slows HR/dec O2 demand, NO reflex tachy, dec cardiac inotropy (contractility)
- dec afterload
- peripheral vasodilator
-

Front 33

how does Verapamil help angina?

Back 33

- dec O2 demand (dec HR)
- inc O2 supply (vasodilator)
- inhibits vasospasm

Front 34

SE of Verapamil?

Back 34

myocardiac depressant
-->brady, transient asystole
-->arrythmias
worsening of HF

Front 35

you would probably get sued if you gave Verapamil to this pt....

Back 35

pt w/ pre-existing HF

Front 36

T/F both Verapamil & Diltiazem are more potent vasodilators than the Dyhydropyridines?

Back 36

F

Front 37

2 angina therapy drugs that cause relfex tachy?

Back 37

(the N's)
1. Nitroglycerine
2. Nefedipine
**minimal in Amlodipine

Front 38

3 reasons for using B-blockers to tx angina?

Back 38

1. dec contractility
2. dec HR
3. dec 02 demand (consumption)
--->all leading to dec freq of attacks & improved exercise tolerance

Front 39

4 names of B-blockers?

Back 39

(the -olol's)
1. Metoprolol
2. Timolol
3. Atenolol
4. Propranolol

Front 40

what is the Mainstay in prophylactic anti-angina therapy?

Back 40

B-blockers

Front 41

what drug can you combine B-blockers w/ to dec its reflex tachy?

Back 41

Nitroglycerine

Front 42

METOPROLOL crazy good benefits?

Back 42

B1 adrenergic rec antagonist
- dec contractility / AV nodal conduc
- dec HR / O2 demand
- prolong diastolic interval
- anti-HTN w/ chronic therapy
---->dec afterload
---->dec Renin/SNS activity
- antioxidant mech

Front 43

SE of B-blockers? take a guess...

Back 43

- yep, cardiac depression
- CNS effects - sedation, insomnia, depression
-***undesirable B2 adrenergic rec blockade**** (ex propranolol)

Front 44

what is a SE you need to be concerned about when Rx Propranolol?

Back 44

- block of B2 rec in lungs leading to worsening of Asthma
- block of B2 rec in peripheral skel arteries in pts w/ severe peripheral vascular dx

Front 45

what do you give to reverse B-blockers adverse SE in emergencies?

Back 45

- Glucagon
- Isoproterenol

Front 46

probably going to get sued if you give angina pt these 2 drugs together in normal doses...especially if pt already has low BP?

Back 46

B-blockers & Ca-channel blockers (especially Verapamil & Diltiazem)
- b/c both cause cardiodepression

Front 47

T/F its ok to discontinue B-blockers abruptly?

Back 47

F, i mean come on

Front 48

what is Ranolazine?

Back 48

-new drug targeting late Na+ influx thus dec intracellular Ca++
--also inhiits FA oxidation thus promoting glucose utilization

Front 49

when should you not use Ranolazine?

Back 49

- pts w/ prolonged Q-T interval
- pts w/ Liver/Renal dx
- w/ people getting Verapamil, Diltiazem, Ketoconazole

Front 50

2 drug eluting stents?

Back 50

1. Paclitaxel (taxol)
2. Sirolimus (Rapamycin)