Mmc Mhs Pharmacology - Cardiovascular Pharmacology Iii

Front 1

Drugs used to treat angina

Back 1

1) Nitrates


2) Beta blockers


3) Calcium channel blockers

4) Sodium channel blockers

Front 2

Types of nitrates

Back 2

1) Nitroglycerin (prototype)


2) Isosorbide dinitrate


2) Isosorbide mononitrate

Front 3

Nitrates – Mechanism of Action

Back 3

1)


1) A prodrug of nitric oxide that increases NO levels, resulting in smooth muscle relaxation and venodilation


2) primarily works on arteries and veins; no direct effects on cardiac muscle

3) Decrease O2 demand and increase O2 delivery

Front 4

Clinical Uses of Nitrates

Back 4

1) Effective in staable (effort -induced) and variant (rest) angina pectoris

2) Works rapidly to relieve symptoms

Hint 4

(given oral or transdermal)


3) Acute coronary syndrome (given IV)

Front 5

Side effects of Nitrates

Back 5

1) Tachycardia


2) Postural hypotension


3) Throbbing headache

4) Facial flushing

NOTE: Contraindicated in patients taking phosphodiesterase V inhibitors

Front 6

Beta Blockers –Mechanism of Action

Back 6

1) Acts primarily on the heart


2) Inhibits beta adrenergic receptors


3) Decreases heart rate, cardiac output, and blood pressure

4) Decreases myocardial O2 demand

Front 7

Clinical Uses of Beta Blockers

Back 7

Prevent effort angina

Front 8

Contraindications of Beta Blockers

Back 8

1) Do not use in patients with asthma, diabetes, COPD, and severe bradycardia

2) When discontinuing drug, dose has to be gradually tapered off in order to prevent rebound angina, MI and hypertension

Front 9

Types of Calcium Channel Blockers

Back 9

1) Dihydropyridines (Nifedipine, Amlodipine)


2) Phenylalkylamines (Verapamil)


3) Benzothiazepines (Diltiazem)

Front 10

Calcium Channel Blockers – Mechanism of Action

Back 10

1) Blocks L–type calcium channels in heart and blood vessels; results in decreased intracellular calcium

2) Decrease O2 demand and increase O2 delivery

Front 11

Clinical Uses of Calcium Channel Blockers

Back 11

Useful for both effort induced angina and vasospastic angina

Front 12

Ranolazine – Mechanism of Action

Back 12

1) Blocks late inward sodium current in myocardial cells, resulting in decreased calcium accumulation

2) Improves diastolic function

3) Decreases oxygen demand

Front 13

Clinical Uses of Ranolazine

Back 13

Used to treat chronic angina or when other antianginal therapies have failed

Front 14

Nifedipine

Back 14

1) Calcium channel blocker

2) Functions mainly as an arteriolar vasodilator; has minimal effects on cardiac conduction or heart rate

Front 15

Side effects of Nifedipine

Back 15

1) Flushing, headache, hypotension and peripheral edema (due to vasodilator effect)

2) Constipation

3) Reflex tachycardia

Front 16

Verapamil

Back 16

1) Calcium channel blocker

2) Causes greater negative inotropic effect than nifedipine, but is a weaker vasodilator

Front 17

Types of angina

Back 17

1) Effort induced (also known as stable, classical or typical angina)

2) Unstable angina

3) Rest angina (also known as Prinzmetal, variant or vasospastic angina)

Front 18

Tolerance of Nitrates

Back 18

1) Can occur rapidly after drug administration

2) Drug sensitivity restored after a daily nitrate-free interval (usually ~ 10-12 hours at night)