Antianginal agents

Question 1

What 3 classes of medications are used to treat angina?

Answer 1

Nitrates
Calcium channel blockers
Beta-Blockers

Question 2

Give 3 examples of nitrates

Answer 2

Nitroglycerine
Isosorbide mononitrate
Isosorbide dinitrate

Question 3

Give 3 examples of calcium channel blockers

Answer 3

Amlodipine
Diltiazem
Verapamil

Question 4

Give 2 examples of beta blockers

Answer 4

Metoprolol

Atenolol

Question 5

Mechanism of action for nitrates?

Answer 5

Drugs converted to NO in endothelial cells
This increase cGMP causing vasodilation (venules>arterioles), which decreases preload and decreases myocardial O2 demand.
It also dilates coronary vessels which increases O2 supply

Question 6

Routes of administration for nitrates?

Answer 6

Oral, transdermal, SL, IV

Question 7

Adverse effects to nitrates?

Answer 7

Headache, hypotension, syncope, flushing, reflex tachycardia

Question 8

DDIs with nitrates?

Answer 8

PDE-5 inhibitors (sildenafil) cause unsafe BP drop

Question 9

1st line choice for an acute anginal episode?

Answer 9

SL nitroglycerine

Question 10

MOA of CCBs in angina?

Answer 10

Block L-type Ca++ channels in smooth muscle leading to vasodilation (arterioles>venules), causing decreased afterload and decreased myocardial O2 demand.
Also dilates coronary arteries increasing O2 supply.

Question 11

How are CCBs metabolized?

Answer 11

CYP450

Question 12

What is the benefit to giving nitrates sublingual?

Answer 12

There is a high first pass effect, SL allows drug to enter through capillaries in mouth and avoid the liver.

Question 13

Adverse effects of CCBs?

Answer 13

Negative chronotropic (Decrease HR, AV block) (V>D)
Negative ionotropic (V>D)
Hypotension, dizziness
Peripheral edema (A>D>V)
Constipation (Most commonly V)

Question 14

DDIs with CCBs?

Answer 14

Grapefruit juice increases Cp

CYP450 inducers decrease Cp

Question 15

When are CCBs a good choice for treatment of angina?

Answer 15

Variant angina
or
Stable angina if B-blockers are poorly tolerated

Question 16

MOA of B-blockers in angina treatment?

Answer 16

Block cardiac B1 receptors causing decreased HR/BP/Contractility, which decreases myocardial O2 demand.
No effect of myocardial O2 supply because it is NOT A VASODILATOR

Question 17

Which is primary renal metabolism, metoprolol or atenolol?

Answer 17

Atenolol

Question 18

Adverse effects of beta blockers?

Answer 18

Decrease in contractility can cause acute HF
Can cause bronchospasms and worsen asthma
Increase blood lipids
Decrease peripheral circulation
Increase lipid solubility
Increase CNS ADRs causing sedation, sleep disturbances, fatigue
avoid in severe bradycardia, PVD, asthma,

Question 19

DDIs with Beta blockers

Answer 19

Do not use with other negative ionotropic or chronotropic agents

Question 20

1st line choice for chronic stable angina?

Answer 20

B blockers