Anti-Anginal/STEMI meds Flashcards
Organic Nitrates indications (short vs long acting)
If short: acute treatment for symptomatic relief of angina pectoris
if long: prevents recurrent anginal episodes; NOT for acute episode
Nitrate (short acting) meds/route/use
- Nitroglycerin (NTG)
- route: sublingual (SL) tablet/spray/powder
- use: short onset/duration; PRN
Nitrate (long acting) meds/route/use
- Isosorbide DInitrate or MONOnitrate
- route: PO
- use: slow onset/long duration; preventative
Nitroglycerin MoA
- Nitrates converted to nitric oxide (NO) –> vessel relaxation/vasodilation
- less work, less O2 demand/afterload
Nitroglycerin pharmacodynamic effects
- reduced left ventricular volume/tension (preload)
- reduced vascular resistance (afterload)
- reduces spasms and improves O2 delivery
Nitrates adverse effects
- headache
- hypotension, flushing, orthostasis
- reflex tachycardia
- dizziness
- tolerance/tachyphylaxis (reversible)
Nitrates D-D interactions
avoid combo with:
- PDE-5 inhibitors
- HTN/pulmonary HTN drugs
(all lead to major drop in BP)
Beta-blocker indication/outcome
- long-term treatment of stable angina pectoris
- reduced risk of death
- will suppress reflex tachycardia (happens with nitrate use)
Beta-blocker meds/selectivity
- metoprolol & atenolol (beta-1 cardioselective)
- nadolol & propranolol (beta-1/beta-2 non selective)
Beta-blockers MoA/effects
block B1 receptors
- decreases cAMP
- no Ca2+ influx
- reduced HR/contractility/oxygen demand
- also B2 receptors –> broncho/vaso-dilation (increase in oxygen delivery)
Beta-blocker AEs
- Common: bradyarrhythmia, hypotension, bronchospasm
- Less: N/V/D
- Sig: heart block
BB contraindications
- asthma
- severe bradycardia
- AV block
- severe LV failure
BB D-D interactions
- with other drugs of similar affects (ex. CCBs): bradycardia, hypotension, AV block
- antagonistic effects: albuterol/catecholamine
- CYP2D6 inhibitors ex. some SSRIs
- CYP2D6 inducers ex. rifampin
Calcium channel blockers indication/outcomes
- Treatment of angina at rest (chronic, vasospastic, unstable)
- no proven mortality benefit
CCBs meds/type
- Nifedipine XL (dihydropyridine aka in arterioles)
- verapamil & diltiazem (non-dihydropyridine aka in cardiac cells)