Antianginal And Lipid Lowering Drugs

Front 1

What does Angina pectoris mean?

Back 1

Pain in the chest

Front 2

Where does the pain from angina pectoris come from?
Where does the most common cause of this phenomenum come from?
Where can it also result from?

Back 2

- Ischemia (hypoxia) in the coronary arteries
- Coronary artery atherosclerosis = reduced oxygen delivery to the myocardium
- Vasospasm

Front 3

Where does Angina pectoris present itself?

Back 3

Massive pain radiating in the left arm, back, or jaw

Front 4

What commonly accompanies Angina symptoms?

Back 4

Fear
Anxiety
Feeling Suffocated
Tight chest

Front 5

What are the three types of Angina pectoris?

Back 5

Chronic stable angina (exertional)
Variant angina (Prinzmetal’s)
Unstable angina (Pre-infarction angina)

Front 6

What are the different antianginal classes of drugs?

Back 6

- Nitrates and Nitrites
- Β-Adrenergic Receptor Blockers
- Ca++ Channel Blockers
- Ranolazine (Ranexa)

Front 7

What antianginal drugs apply direct relaxation of vascular smooth muscle by the metabolite nitric oxide (NO), resulting in vasodilation in first veins in low doses and then in arteries at higher doses

Back 7

Nitrates an Nitrites

Front 8

What are the Nitrates and Nitrite drugs that are used in antianginal therapy?

Back 8

Nitroglycerin
Isosorbide Mononitrates

Front 9

What drug is used for acute angina symptoms and prophylaxis of angina symptoms?

Back 9

Nitroglycerin

Front 10

What are the two forms of isosorbide mononitrates

Back 10

Immediate release and sustained release

Front 11

What are the adverse effects of using Nitrates and Nitrites?

Back 11

- Headache (most common) – dilation of meningeal arteries
- Orthostatic hypotension resulting in reflex tachycardia,
cerebral ischemia, weakness, dizziness, flushing, and syncope
- Risk of methemoglobinemia with large doses
- Tolerance with long-acting preparations

Front 12

What are the drug interactions that must be considered when using Nitrates and Nitrites?

Back 12

Should NOT be used in patients taking sildenafil or similar drugs because of prolonged hypotension

Front 13

What are the contraindications for using Nitrates and Nitrites?

Back 13

Amyl nitrate should NOT be used in pregnant women

Front 14

What is the mechanism of action for B-adrenergic receptor blockers?

Back 14

Prevent binding and receptor activation by epinephrine, norepinephrine, and exogenously
administered adrenergic agonists in tissues regulated by B-adrenergic
receptors

Front 15

What are the B-adrenergic receptor blocking drugs?
What is the most common?

Back 15

Propranolol (Inderal) - most common
Metoprolol (Lopressor)
Atenolol (Tenormin)
Nadolol (Corgard)

Front 16

What are the positive effects of using B-adrenergic receptor blockers?

Back 16

Treating Angina include decreased HR
Depressed myocardial contractility
Decreased cardiac output
Some reduction BP

Front 17

What are the adverse effects of using B-adrenergic receptor blockers?

Back 17

CNS effects – depression, drowsiness, and dreams/insomnia
Cardiovascular effects - hypotension, and decreased HR
General autonomic effects – diarrhea, nasal stuffiness,
xerostomia, asthma, fluid retention

Front 18

What are the interactions and contraindications to using B-adrenergic receptor blockers?

Back 18

- Risk of hypertensive episode w/ administration of local anesthetic agents that contain vasoconstrictors
- Opiods and other CNS depressants should be used with
caution

Front 19

What is the mechanism of action for Ca++ channel blockers?

Back 19

Blocking the slow Ca++ current in vascular smooth muscle and cardiac muscle

Front 20

What are the Ca++ channel blockers?

Back 20

Diltiazem (Cardizem)
Verapamil (Verelan or Calan)
Nifedipine (Procardia)
Felodipine
Amlodipine(Norvasc)

Front 21

Ca++ blockers have been shown to be effective in treating what?

Back 21

- Prophylactic treatment of Angina
- Supraventricular tachyarrhythmias and hypertension

Front 22

What are the general adverse effects of using Ca++ blockers?

Back 22

- Dizziness, headache, and nausea
- Systemic vasodilation – heat, facial flushing, hypotension, reflex tachycardia and peripheral edema

Front 23

What Ca++ blocking drugs can cause decreased HR?

Back 23

Diltiazem and Verapamil

Front 24

What Ca++ blocking drugs influence gingival enlargement with long-term
treatment?

Back 24

Verapamil, diltiazem, nifedipine, and
felodipine

Front 25

What are the contraindications for using Ca++ blocking drugs?

Back 25

Use with B-blockers may increase the blockade of the AV node
conduction

Front 26

What is the mechanism of action for Ranolazine (Ranexa)?

Back 26

Mechanism not well understood

Front 27

What is the pharmacotherapy for Ranolazine (Ranexa)?

Back 27

Approved for chronic stable angina for use as combination therapy when angina is not well controlled

Front 28

What are the adverse effects of taking Ranolazine (Ranexa)?

Back 28

Most common: constipation, nausea, dizziness, and
headache
Rare: tinnitus, vertigo, and dry mouth

Front 29

What are the drug interactions to be aware of when using Ranolazine (Renexa)?

Back 29

Drugs that can cause QT prolongation

Front 30

What are the contraindications for using Ranolazine (Renexa)?

Back 30

Avoid use in patients with congenital long QT syndromes

Front 31

When is combination therapy applied for patients who have angina pectoris?

Back 31

When a patient becomes intolerant or continues to have angina with an optimal dosage of a single medication

Front 32

Cholesterol plays an essential role in human life as an important component of _____ and a precursor of _____ and _____ in addition to its role in _____

Back 32

cell membranes, steroid hormones, bile acids, triglyceride transport

Front 33

How can high blood cholesterol levels cause premature death?

Back 33

Coronary Artery disease

Front 34

What disease is the primary cause of premature death which is caused by deposition of cholesterol in the arteries?
What does this disease deposit in large arteries?

Back 34

Atherosclerosis
Plaques

Front 35

What are the guidelines for patient cholesterol management?

Back 35

Pharmacotherapy and lifestyle changes
Increased exercise and decreased fat and cholesterol intake

Front 36

What are the pharmacotherapy classes of drugs that are used as lipid lowering drugs?

Back 36

- Fibric Acid derivatives
- Nicotinic Acid
- Bile Acid sequestrants
- 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibitors
- Cholesterol Absorption Inhibitors
- Fish oils

Front 37

Fibric Acid derivatives Increase the activity of _____, decrease the _____, and increase _____ in mitochondria and peroxisomes

Back 37

extrahepatic lipoprotein lipase, hepatic synthesis of fatty acids, hepatic fatty acid oxidation

Front 38

Fibric Acid derivatives influence all the _____, but are most effective in
familial type _____ and in patients with elevated _____ concentrations

Back 38

lipoproteins, 3 hyperlipoproteinemia, VLDL

Front 39

Fibric Acid derivatives cause Inhibition of _____ and an increase in the _____, promote a reduction in LDL
in patients without coexisting _____.

Back 39

cholesterol synthesis, biliary excretion of cholesterol, hypertriglyceridemia

Front 40

What are the fibric acid derivative drugs?

Back 40

Gemfibrozil (Lopid)
Fenofibrate (Tricor)

Front 41

The effects of Gemfibrozil (Lopid) is that it
- decreases the concentrations of ______
- Increases _____
- Decreases _____ by 34% over 5
years

Back 41

- Blood triglycerides, cholesterol, VLDL, IDL, and sometimes LDL
- HDL
- myocardial infarction

Front 42

What are the adverse effects for using Fibric acid derivatives?

Back 42

Gastrointestinal disturbances and cholelithiasis

Front 43

What is the contraindication for using Gemfibrozil by itself?

Back 43

Enhances the action of oral anticoagulants

Front 44

What drugs are contraindicated with Gemfibrozil use?
What is their combined action?

Back 44

- HMG-CoA reductase inhibitors
- Increased risk of rhabdomyolysis and myoglobinuria

Front 45

Nicotinic acid drugs:
Inhibit _____ synthesis through inhibition of _____ and inhibition of subsequent delivery of _____ to produce _____ for packing into _____ particles

Back 45

VLDL, adipose tissue lipolysis, fatty acids to the liver, triglycerides, VLDL

Front 46

What is unique to the Nicotinc Acid drugs?
What is it most useful in defending against?

Back 46

- Broadest spectrum of activity of the lipid-lowering agents
- Hyperlipdemia

Front 47

Nicotinc acid drugs are used most often to reduce _____ while
increasing _____ levels

Back 47

VLDL and LDL, HDL

Front 48

What is the most common Nicotinc acid drug?

Back 48

Niacin (Niaspan)

Front 49

What are the adverse effects in using Nicotinc acid drugs?

Back 49

Cutaneous flushing, pruritus, and gastrointestinal distress
(effects 50% of patients taking the nicotinic acid and decreases adherence)

Front 50

How can one prevent some of the adverse effects of using Nicotinc Acid drugs?

Back 50

- Slowly taper to decrease above side effects
- Aspirin can be used to decrease flushing

Front 51

The mechanisms of action of the Bile acid sequestrant drugs are as follows:
- Nonabsorbable _____ resins that bind _____ in the intestinal lumen, prevent _____, and promote
their _____
- Hepatic cholesterol conversion to bile acids is _____, and plasma cholesterol and LDL concentrations are _____
- _____ concentrations are reduced

Back 51

- anion exchange, bile acids, reabsorption, excretion in the feces
- accelerated, decreased
- LDL

Front 52

What are the Bile acid sequestrant drugs?

Back 52

Cholestyramine (Questran and Prevalite)
Colestipol (Colestid)
Colesevelam (Welchol)

Front 53

What is unique about the bile acid sequestant drugs?

Back 53

Resins that are mixed with liquid and drunk as a slurry

Front 54

What is the intended combinations of use for bile acid sequestrant drugs?

Back 54

Use alone or in combination with nicotinic acid and cholesterol synthesis inhibitors

Front 55

What are the adverse effects for using bile acid sequestrants?

Back 55

Gastrointestinal upset and constipatioin

Front 56

What are the major contraindications to using bile acid sequestrants?

Back 56

No major contraindications

Front 57

What is 3H3MCARI?
What else is it known as?
What do they do?

Back 57

- 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor
- "statins"
- Inhibit the biosynthesis of cholesterol

Front 58

What are statins competetive antagonists of?

Back 58

Competitive antagonists of HMG-CoA binding

Front 59

What drugs are the best tolerated, most effective drugs, and most commonly prescribed for lowering LDL cholesterol and for reducing
stroke, coronary heart disease, and overall mortality?

Back 59

Statins or
3-hydroxy-3-methylglutaryl Coenzyme A reductase inhibitors

Front 60

What are the statin drugs?

Back 60

Atorvastatin (Lipitor)
Simvastatin (Zocor)
Pravastatin (Pravachol)
Lovastatin (Mevacor)
Rosuvastatin (Crestor)

Front 61

What are the adverse effects for using statins?

Back 61

Myalgia
Blurred vision
Constipation
Diarrhea
Gas
Heartburn
Stomach pain
Dizziness
Headache
Nausea
Skin rash
Impotence
Insomnia
Rhabdomyolysis

Front 62

What are the drug interactions to be aware of when using Statins?

Back 62

Increase the anticoagulant effect of warfarin

Front 63

What are the contraindications to using Statins?

Back 63

Pregnant women should not use statins

Front 64

What is the mechanism of action for cholesterol absorption inhibitors?

Back 64

Inhibit cholesterol uptake by the intestinal absorptive
epithelium

Front 65

What are the cholesterol absorption inhibitor drugs?

Back 65

Ezetimibe (Zetia)

Front 66

What are the adverse effects of using cholesterol absorption inhibitor drugs?

Back 66

Gastrointestinal

Front 67

What are the known drug interactions to be aware of when using cholesterol absorption inhibitor drugs?

Back 67

No known interactions

Front 68

What are the contraindications to using cholesterol absorption inhibitor drugs?

Back 68

No major contraindications

Front 69

What are the mechanisms of action for using fish oils as lipid lowering agents?

Back 69

- Unclear: Possibly antioxidant effects
- Small decrease in levels of plasma cholesterol, triglycerides, and VLDL and small increase HDL levels

Front 70

What are the common fish oils used?

Back 70

Fatty Acid (Lovaza)

Front 71

What are the adverse effects of using fish oils?

Back 71

Dyspepsia and taste perversion

Front 72

What are the known drug interactions to be aware of when using fish oils?

Back 72

No known drug interactions

Front 73

What are the main contraindications to using fish oils?

Back 73

No contraindications to use

Front 74

Lipid-lowering drugs from the different categories are used in
combination for 3 reasons what are they?

Back 74

- More profound reduction
- Smaller doses of drugs to reduce adverse events
- Some drugs may elevate certain lipid concentrations, combined therapy with a drug of another category can be
used to overcome this unwanted effect

Front 75

What is the only combination lipid lowering drug?

Back 75

Simvastatin/ezetimibe (Vytorin)