Angina Pectoris

Question 1

What are modifiable for CAD(Coronary Artery Diseases

Answer 1

1. HTN
2. High Cholesterol
3. DM
4. Smoking
5. Obesity

Question 2

What are uncontrollable non modifiers in CAD

Answer 2

1. Age
2. Sex
3. Race
4. Heredity

Question 3

Drugs used in treatment of Angina Pectoris

Answer 3

1. Nitrates
2. Beta blocker
3. Ca2+ blockers
4. Metabolic modifier
5. Ivabradine

Question 4

How does NO(Nitric Oxide) works

Answer 4

Work by activation of Nitric Oxide (NO)
eNOS(endothelial nitric oxide synthase) can be activated by:Acetylcholine, histamine, bradykinin, and serotonin.
NO+++
GTP ——–> c GMP———> Relaxation
Guanylyl cyclase

Question 5

How Nitrates decreases cardiac oxygen demand?

Answer 5

Dilation of large veins lead to decrease preload and decrease
cardia work (decrease oxygen demand)

Question 6

How Nitrates increase cardiac oxygen supply?

Answer 6

At high doses, nitrates cause arteriolar dilation (aorta)
leading to decrease of afterload (increase oxygen supply)

Question 7

Other benefits of Nitrates:

Answer 7

Improve Collateral blood flow
Decrease coronary vasospasm
Inhibits platelets aggregation

Question 8

Nitrates used clinically?

Answer 8

Nitroglycerin
1.Given sublingual, PO, transdermal, and IV forms
2. Isosorbide (Extended release)
Given PO

Question 9

Side effects of Nitrates

Answer 9

Headache, flushing, and syncope
Reflex tachycardia and edema
Tachyphylaxis: Acute tolerance

Question 10

Treatment of Methemoglobinemia

Answer 10

Methylene blue

Question 11

Methemoglobinemia was reported with the use of _______

Answer 11

Amyl nitrate

Question 12

________is converted to cyanide and may cause Cyanide poisoning

Answer 12

Sodium nitroprusside

Question 13

What is the treatment of cyanide poisoning?

Answer 13

1. Sodum thiosulfate, Amyl nitrite, Sodium nitrate
2. Vit B12

Question 14

Drug interactions: PDE5 inhibitors

Answer 14

Always ask the patient with chest pain at the ER if they took
sildenafil earlier.
It could be a deadly combination with Nitrate causing severe hypotension

Question 15

What is Beta blocker MOA?

Answer 15

Act directly on the heart. No direct effect on blood vessels.
Decrease the force of contraction, HR and CO causing decrease
in oxygen demand

Question 16

Most _______ blocker have been use in angina?

Answer 16

Beta blocker
Atenolol, metoprolol, bisoprolol, and propranolol

Question 17

Cautions with Prinzmetal’s Angina

Answer 17

Beta blockers are contraindicated as they keep alpha 1 open
causing vasospasm.

Question 18

Calcium Channel Blockers two types and name?

Answer 18

Dihydropyridine: Amlodipine and Nifedipine
Nonhydropyridine: Verapamil and diltiazem

Question 19

Name the Cat+ channel blocker not used in US and MOA?

Answer 19

Bepridil is not used in the US
It dilates the coronary arteries
Blocks Na+ and K+ channels and may cause Torsades de Pointes

Question 20

What is the name of a Metabolic modifier used in angina and the moa? contraindicated?

Answer 20

Ranolazine
It blocks late inward Na+ current
No effect on blood pressure or HR
Contraindicated with antiarrhythmic drugs class I and III due to prolongation of QT interval

Question 21

What drug is Used in chest pain with CHF with LVEF<35%?

Answer 21

Ivabradine
Used in chest pain with CHF with LVEF<35%
Decreases heart rate by blocking the funny channel (IF current)
Used in patients who cannot tolerate BB blockers

Question 22

What is the side effects of Ivabradine?

Answer 22

Bradycardia, AV block
Luminous phenomena (IF channel in the retina)

Question 23

Which of the following drugs is pivotal in Rx of Anginal Pectoris?

Answer 23

A. HCTZ
B. Lisinopril
C. Propranolol
D. Nitroglycerin