Drug Therapy of Angina Pectoris Lecture PDF

Question 1

Most common source of angina is due to what underlying physiologic mechanism?

Answer 1

Atherosclerosis

Question 2

3 types of angina

Answer 2

• chronic stable (exertional)
• variant (vasospastic)
• unstable (part of acute coronary syndrome)

Question 3

Nitroglycerin DOC and mech of action

Answer 3

• Drug of choice for acute anginal attacks
• Acts directly on vascular smooth muscle to promote vasodilation, acts mostly on veins in peripheral vasculature than arteries (reduces O2 need for heart muscle)

Question 4

Nitroglycerin therapeutic uses (3)

Answer 4

• treat acute angina to abort ongoing attack
• treat chronic stable angina by decreasing cardiac oxygen demand
• variant angina treatment relaxing vasospasm of coronary arteries increasing oxygen supply

Question 5

Nitroglycerin ADR’s (3)

Answer 5

• headache (can be diminished over time)
• orthostatic hypotension
• reflex tachycardia (can be prevented by coadministration with B1 receptor or Ca2+ channel blocker)

Question 6

Nitroglycerin drug interactions (2)

Answer 6

• intensifies other hypotensive drugs

- phosphodiesterase type 5 inhibitors for ED (sildenafil and such) causes drop in blood pressure

Question 7

Nitroglycerin drug tolerance

Answer 7

-occurs with depletion of sulfhydryl groups in VSM and can develop rapidly over the course of a day, preventing from nitroglycerin from being converted to active form nitric oxide, development is more likely with high dose or uninterrupted therapy, can prevent by witholding for period of time (over night) to replensih sulfhydryl groups

Question 8

Nitroglycerin for prophylaxis of angina

Answer 8

Preparations used to be taken just prior to anticipated exertion to prevent an attack from occurring

Question 9

Nitroglycerin administration (4)

Answer 9

• sublingual tablet for direct short term effect (can take up to 2 additional tablets at 5 min intervals, if doesn’t relieve then probably MI)
• oral capsule for long term prophylaxis
• ointment or patch
• IV (often for CHF associated with acute MI)

Question 10

B adrenergic blocking agents are important for treating ___ angina pectoris but are not effective against _______

Answer 10

stable, vasospastic angina

Question 11

B blocker sudden abrupt withdrawal

Answer 11

results in excess of sensitive B 1 adrenergic receptors that can increase incidence and intensity of anginal attacks, may precipitate an MI

Question 12

B blockers should not be used in patients with these 3 conditions

Answer 12

• sick sinus syndrome
• heart failure
• 2nd or 3rd degree heart block

Question 13

3 most common Ca2+ channel blockers

Answer 13

• verapamil
• dilitiazem
• nifedipine

Question 14

Ca2+ channel blockers can treat ___ and ___ angina

Answer 14

variant (cardiac spasm)

classic (reduce o2 demand on heart)

Question 15

Ranolazine (ranexa) function

Answer 15

Approved for treatment of angina in patients that have not adequately responded to nitrates, BB or CCB’s and should be combined with at least one of these drugs, act by unknown mechanism

Question 16

Ranolazine (ranexa) ADR’s

Answer 16

• dose dependent increased QT interval (risk of torsades de pointes)
• elevation of BP in patients with severe renal impairment

Question 17

Torsades de pointes

Answer 17

Uncommon and distinctive tachycardia characterized by twisting of QRS complexes often brought on by prolonged QT interval, can resolve spontaneously or develop into ventricular fibrillation and death