Pharm Block 2- Anti-Anginal Drugs

Front 1

angina pectoris

Back 1

-primary symptom of ischemic heart disease
-dt an imbalance btw myocardial O2 supply and demand
-chest pain occurs dt accum of metabolites resulting from ischemia

Front 2

typical stable angina

Back 2

-continuous obstruction of large vessels due to atheroma
-pain on exertion

Front 3

variant angina

Back 3

-spastic, Prinzmetal's
-transient spasm of localized portions of large coronary vessels
-usually assoc with underlying atheromas
-15% of cases

Front 4

unstable angina

Back 4

-crescendo
-changes or worsens rapidly
-assoc with high risk for MI and death

Front 5

determinants of O2 demand

Back 5

-contractile state
-HR
-wall tension (systolic from afterload, diastolic from preload)

Front 6

law of LaPlace

Back 6

tension= pressure*radius/ thickness

Front 7

coronary blood flow in stable angina

Back 7

-reduced blood flow dt reduced pressure gradient
-can be diminished furher with inc intraventricular pressure
-inc HR also dec subendocardial blood flow

Front 8

coronary blood flow in variant angina

Back 8

-vasospasm results in transmural ischemia

Front 9

pharmacotherapy for acute vs chronic stable angina

Back 9

-acute: fast-acting nitrates
-chronic: B-blockers, nitrates, CCBs

Front 10

pharmacoptherapy for acute vs chronic variant angina

Back 10

-acute: fast-acting nitrates
-chronic: CCBs

Front 11

nitrate uses

Back 11

-acute episodes of angina
-chronic treatment of typical stable angina

Front 12

nitrate mech's

Back 12

-denitrated by glutathione s-transferase --> free nitrate released and converted to NO
-NO activates guanylyl cyclase, inc cGMP
-general vasodilator, larger effect on veins

Front 13

nitrate effects

Back 13

-inc venous capacitance and dec preload
-results in reduced wall tension and therefore O2 demand
-dec preload= minor effect to inc subendocardial blood flow
-small dec in afterload from arterial dilation
-coronary vasodilator

Front 14

nitrate pharmacokinetics

Back 14

-nitroglycerin and isosorbide dinitrate inactivated in liver
-low oral bioavailability

Front 15

nitrates used for acute episodes

Back 15

-nitroglycerin (sublingual)
-isosorbide dinitrate (sublingual)

Front 16

chronic therapy

Back 16

-isosorbide dinitrate (extensive first pass)
-isosorbide mononitrate (NO first pass)
-nitroglycerin (tablet, patch, ointment)

Front 17

nitrate s/e

Back 17

-CV actions
-hypotension, otrho hypoTN, tachy, throbbing headache (menigeal vasodilation)

Front 18

tolerance to nitrates

Back 18

-complete tolerance can develop if used for more than a few hours
-also reverse rapidly (24h after stop taking drug)
-develops with ALL nitrates

Front 19

B blockers to treat angina

Back 19

-mainly used for chronic treatment of typical stable angina
-blocks postive iono and chronotropic actions of catecholamines on heart mediated by B1
-dec HR, contractility, bp
-small inc in O2 supply to ischemia areas (dt dec HR)

Front 20

b blocker c/i

Back 20

-asthma and bronchspasm
-bradycardia
-AV block
-caution in pts with coronary spasm

Front 21

CCBs and angina

Back 21

-dec HR, contractility, wall stress (secondary to dec bp)
-inc endocardial blood flow (dec HR and dilate vessels)
-relieve and help prevent spasms

Front 22

CCBs and stable angina

Back 22

-verapamil and diltiazem
-greater effects on cardiac muscle

Front 23

CCBs and vasospastic angina

Back 23

-nifedipine
-more pronounced vascular actions
-should be used with a B blocker to prevent hypotension and reflex tachycardia

Front 24

ranolazine

Back 24

-blocks Na+ current in cardiac muscle during ischemia
-results in dec Ca overload during ischemia
-only used in typical stable angina unresponsive to other therapies

Front 25

combo therapy and wall tension

Back 25

-nitrates prevent it
-B blockers produce it

Front 26

combo therapy and HR

Back 26

-nitrates inc HR and contractility
-B blockers prevent it

Front 27

combo therapy and vasospasm

Back 27

-nitrates prevent it
-b blockers cause it

Front 28

combo therapy and oxygen consumption

Back 28

-both reduce it
-nitrates dec preload
-b blockers dec work of the heart

Front 29

combo therapy and subendocardial blood flow

Back 29

-both increase it
-nitrates dec preload, improve gradient
-b blockers dec HR