Anti-anginal drugs

Question 1

how long do angina pectoris usually last?

Answer 1

15s - 15 mins

Question 2

what is the immediate cause of angina pectoris?

Answer 2

imbalance between myocardial O2 supply and demand

Question 3

what is the differnce in the vessels in stable angina vs unstable angina

Answer 3

both will have narrowed lumen due to a plaque but with unstbale angina the plaque will be ruptured and will have platelet aggregation and thrombus formation

Question 4

is there plaques or lumen narrowing associated with variant angina?

Answer 4

NO, has innappropriate vasopasm

Question 5

in addition to plaque rupture, what is another cause of unstable angina?

Answer 5

if the diseased coronary artery endothelium is unable to produce NO and prostacyclin tha inhibit platelet aggregation and clot formation

Question 6

variant and unstable angina can result if the endotheiium is unable to make _____ and _____ which inhibit _______ and _______

Answer 6

NO and prostacyclin; inhibit platelet aggregation and clot formation

Question 7

causes of variant/prinzmental angina

Answer 7

• enhanced sympathetics- damaged endothelium cannot make NO

Question 8

__________ drugs are used to increase oxygen delivery AND decrease oxygen demand

Answer 8

vasodilators

Question 9

what 4 classes of drugs are used to treat angina?

Answer 9

• nitrates: isosorbide dinitrate, nitroglycerin, sodium nitroprusside- beta blockers- calcium channel blockers: amlodipine, nifedipine, diltiazem and verapamil- sodium channel blockers: ranolazine

Question 10

nitrates cause what to O2

Answer 10

decrease in the myocardial oxygen demand via systemic vasodilation
increase oxygen delivery by dilating coronary vessels

Question 11

what are three functions of NO?

Answer 11

• vasodilation- anti-thrombotic- anti inflammatory(all involve the NO stimulated formation of cGMP)

Question 12

when is IV nitroglycerin given?

Answer 12

unstable angina + acute heart failure

Question 13

_______ is the first line treatment for acute anginal symptoms

Answer 13

sublingual nitroglycerin

Question 14

what nitrate is given for prophylaxis? and why?

Answer 14

isosorbide mononitrate and is given ORALLY

takes longer to see effects (1hr)

Question 15

how can nitrate tolerance be overcome:

Answer 15

daily nitrate free intervals (10-12 hr)

Question 16

what is the most common AE of nitrates?

Answer 16

headache due to cerebral vasodilation

Question 17

high doses of nitrate can cause:

Answer 17

• postural hypotension
• facial flushing
• reflex tachycardia

Question 18

_______ is contraindicated with nitrates

Answer 18

sildenafil

Question 19

what is the MOA of sildenafil?

Answer 19

inhibits the enzymes phosphodiesterase 5 which then will inhibit the breakdown of cGMP leading to an increase in available cGMP causing vasodilation

Question 20

________ is used to treat severe hypertensive emergencies and severe heart failure

Answer 20

sodium nitroprusside

Question 21

cyanide intoxication is an AE of ______

Answer 21

sodium nitroprusside

Question 22

what patients are recommend to use beta blockers?

Answer 22

patients with stable angina and have acute coronary syndrome or those with left ventricular dysfunction

Question 23

beta blockers are contraindicated in the treatment of _______

Answer 23

variant angina; don’t want to block the beta2 vasodilatory effect (even when you give a beta 1 selective because selective has some effect on beta2)

Question 24

what drugs are used to treat variant angina?

Answer 24

calcium channel blockers or nitrates

NOT BETA BLOCKERS

Question 25

_____ type calcium channels is dominant in cardiac and smooth muscle

Answer 25

L type

Question 26

what are the dihydropyradines and what do they act on?

Answer 26

nifedipine and amlodipine;

mainly acts on VASCULATURE

Question 27

what should you not give patients who have a preexisting cardiac depression or with an AV conduction abnormalities

Answer 27

verapamil (calcium channel blockers that are specific to the heart)

Question 28

digoxin levels can increase when given _____ because it can displace it from its binding sites

Answer 28

verapamil (calcium channel blocker)

Question 29

which non dihydropyradine decreases HR more?

Answer 29

verapamil

Question 30

MOA of ranolazine?

Answer 30

blockade of sodium current that facilitates the calcium entry via Na/Ca exchanger; usually this exchange will bring sodium in and push calcium out but in this when there is angina there is less ATP and so the Na/K ATPase pump doesn’t work so there is more sodium inside the cell thus REVERSING the direction of the Na/Ca exchanger

Question 31

ranolazine lead to _______ intracellular calcium

Answer 31

decreased;

Question 32

adverse effects of ranolazine

Answer 32

last line treatment; QT interval prolongation

Question 33

treatment regiment for stable angina:

Answer 33

nitrates > beta blockers > calcium channel blockers > ranolazine

Question 34

treatment regiment for variant angina?

Answer 34

nitroglycerin and calcium channel blockers (NO beta blockers)

Question 35

can you use beta blockers to treat angina in a patient with chronic renal disease?

Answer 35

yes, but after giving nitrates, calcium channel blockers have shown to give better outcomes

Question 36

what is the effect on the end diastolic volume when giving beta blockers or calcium channel blockers?

Answer 36

EDV will increase (depends on patient)

Question 37

when nitrates + beta blockers or calcium channel blockers are given, what are the effects on:
HR, atrial pressure, EDV, contractility and ejection time?

Answer 37

HR: decrease 
atrial pressure: decrease 
EDV: none/decrease 
contractility: none 
ejection time: none