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19 Cards in this Set
- Front
- Back
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What is the cause of stable angina? Variant? Unstable?
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stable - exercise/stress
variant - vasospasm unstable - rupture of plaque/platelet adhesion |
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What are some factors determining myocardial oxygen demand?
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HR, contractily, ventricular wall tension (preload and afterload)
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What are some factors affecting mycoardial oxygen supply?
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Aortic BP, Coronary resistance, oxygen distribution in coronary blood
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What are the 3 main drug classes used to treat Angina?
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Organic Nitrates, Beta-Blockers, Calcium Channel blockers
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Summary of Nitrate CV effects
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Reflex increase in HR
Reflex increase in CO Large Decrease in Preload Small affects on afterload No affect on coronary blood flow |
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Summary of Beta Blocker CV effects
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Large decrease In HR
Large decrease in CO Increase in Preload Decrease in Afterload Decrease in Coronary blood flow |
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Summary of Dihydropyridines CV effects
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Reflex increase in HR
Reflex increase in CO Little change in preload Large decrease in afterload Large increase in coronary blood flow |
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How are Nitrates useful in treating angina?
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decrease preload which leads to a decrease in oxygen deman
no net increase in coronary vessel blood flow, but may dilate the large vessels and the collateral vessels they prevent vasospasms in variant angina |
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How are Beta Blockers useful in treating angina?
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decrease contractility/HR which decreases hearts oxygen demand
may decrease coronary blood flow and may aggravate variant angina |
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How are calcium channels useful in treating angina?
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dilate preipheral and coronary blood vessels
effective in variant angina Non-DHP's have a more dramatic anti-anginal effect due to their decrease in HR and CO |
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What is the main difference between Nitrate/BB and BB/DHP drug combinations?
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Nitrate/BB has a lesser effect on decreasing afterload, and actually decreases coronary blood flow
BB/DHP has contradictory effects on preload, but a more dramatic decreas on afterload, and actually greatly improves coronary blood flow |
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Which drug do dyou not use for variant angina?
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Beta Blockers
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What should you consider in choosing Beta Blockers for angina treatment?
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Beta Blockers have many drug interactions and side effects
Unfavorable uses for BB's - Asthma, depression, diabetes, hyperlipidemia, AV conductions problems, peripheral vascular disease Favorable BB effects - Post MI, Afib, Essential Tremor, Hyperthyroidism, Migranse, Hypertension |
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What should you consider in choosing Calcium blockers for angia treatment?
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Unfavorable CCB effects - HEart block, heart failure, SA node problems
Favorable CCB effects - A fib, diabetes, Migrane |
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A patient comes to you with stable angina, but also suffers from migranes and diabetes, which drug would you prescribe?
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Calcium channel blocker
Can't prescribe BB cause of undesirable effects in patients with diabetes |
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How does Ranolazin work? Uses? DI?
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Prolongs QT interval
used for chronic stable angina affected by CYP3A4 |
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What are the benefits of using aspirin?
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Chronic Angina - decreased likelihood of MI
Unstable angina - decrease mortality Post MI - decreases mortality |
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What other agents are useful in the treatment of unstable angina?
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Heparin
Glycoprotein IIb/IIIa antagonists |
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What is Nicorandil?
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Potassium channel opener
for chronic stable angina - decrease mortality and morbidity not approved in US |
