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30 Cards in this Set
- Front
- Back
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Angina pectoris is caused by...
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coronary blood flow insufficient to meet oxygen demands
Does not cause cellular death |
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How do the antianginal drugs lower oxygen demand?
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Affect BP, HR, and contractility
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Stable angina
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promptly relieved by rest and nitroclycerin (vasodilator)
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Unstable angina
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angina with progressively increasing frequency and is precipitated with progressively less effort
-unrelated to exercise & occurs at rest -sx not relieved by nitro or rest |
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Prinzmetals angina
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occurs at rest due to coronary artery spasm
responds promptly to vasodilators (nitro, CCB) |
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Mechanism of action for Organic Nitrates
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-Relaxes coronary arteries
-Venodilatory activity decrease myocaridial O2 demand by dec venous return -Converts to nitric oxide--> activates guanylate cyclase and inc cells cyclic GMP |
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Effects of organic nitrates on the CV system
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Dilation of large veins, results in pooling of blood
-diminishes pre-load -reduces workload of heart nitro decrease myocaridal O2 consumption because of dec cardiac work |
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Pharmacokinetics
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Onset: 1 min for nitro
First pass: Liver Long duration of action: Isosorbide mononitrate |
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Adverse effects of Organic Nitrates
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Most common: headache
Postural hypotension Facial flushing Cant be taken with Sildenafil (Viagra) for risk of hypotension |
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Tolerance to Nitrates
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Develops rapidly
Vessels become desensitized |
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How do you overcome tolerance to Nitro
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providing daily "nitrate-free interval" of 10-12 hrs at night
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Effects of B-Blockers
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Decrease O2 demand of myocardium by lowering rate and contractility
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Non-cardioselective B-blocker
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propanolol
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All beta blocers are nonselective at high doses
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Can inhibit B2 receptors
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These beta blocking agents should be avoided...
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Agents with intrinsic sympathomimetic activity
(pindolol) |
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Contrainications for B-blockers
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asthma, diabetes, severe bradycardia, PVD, COPD
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Why cant you just remove someone's beta blocker quickly
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may have rebound angina/HTN
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CCB affect on the body
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Vasodilator that decreases smooth muscle tone and vascular resistance
All lower BP |
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CCBs are first line therapy for...
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vasospastic angina
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CCBs are second line therapy for...
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stable angina
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Variant angina controlled by...
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nitrates or CCBs
(BBlockers are contraindicated |
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Dihydropyridine deriviative with minimal effect on cardiac conduction or HR
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Nifedipine
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SE of Nifedipine
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flushing, headache, hypotension, edema, constipation, relfex tachycardia
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CI for Nifedipine
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CAD
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Diphenylalkylamine deriviative that slows cardiac conduction and decreases HR
(negative inotrophic effect) |
Verapamil
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CI for Verapamil
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preexisting depressed cardiac fuction or AV conduction abnormalities
(CHF) |
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SE for Verapamil
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constipation
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Drug that reduces HR but to a lesser extent than verapamil
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Diltiazem
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Indications for Diltiazem
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Can relieve coronary artery spasm and useful in pts with variant angina
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New drug for Angina
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Ranexa (ranolazine)
MOA uncertain use after BB, CCBs, nitrates Lowers HbA1C |
