Angina

Question 1

What is the primary cause of angina?

Answer 1

an imbalance between the oxygen requirement of the heart and the oxygen supplied to it via the coronary vessels

Question 2

Initial drug therapy of angina involves the use of:

Answer 2

• Organic nitrates
• CCBs
• Beta blockers

Question 3

What can be done to increase oxygen to ischemic tissue if reduction of oxygen demand does not control the symptoms of angina?

Answer 3

• Coronary bypass grafts

- Angioplasty

Question 4

Name the Nitrate

Answer 4

Nitroglycerin

Question 5

True or False: Nitroglycerin dilates both arteries and veins

Answer 5

True

Question 6

What is the MOA of nitroglycerin?

Answer 6

Denitrated by glutathione S-transferase resulting in a free nitrite ion which is then converted to NO leading to activation of GC which will increase cGMP which causes vasodilation—the vasodilation decreases arterial pressure, venous return, and intracardiac volume

Question 7

Name the toxicities of Nitroglycerin

Answer 7

• Orthostatic hypotension
• Reflex tachycardia
• Throbbing headache

Question 8

Nitroglycerin is contraindicated if

Answer 8

cranial pressure is elevated

Question 9

Dilation of the epicardial coronary arteries causes a(n) (increase or decrease?) in coronary artery spasm, platelet aggregation, and myocardial oxygen demand

Answer 9

decrease

Question 10

What route of administration works the fastest but has a brief duration of action?

Answer 10

sublingual

Question 11

Longer duration of action is achieved with:

Answer 11

• Oral
• Transdermal slow release preparations
• IV infusion

Question 12

What drugs are contraindicated with the use of Nitrates?

Answer 12

PDE-5 inhibitors

Question 13

Continuous exposure to nitrates causes ______

Answer 13

tolerance

Question 14

True or False: Continuous exposure causes tolerance due to diminished NO release or systemic compensatory mechanisms

Answer 14

True

Question 15

All CCBs tht are currently used in therapeutics are (R or L) type CCB?

Answer 15

L-type

Question 16

What type of CCB is the dominant type in cardiac smooth muscle?

Answer 16

L-type

Question 17

Although CCBs block calcium channels in most types of smooth muscle, _________ smooth muscle appears to be the most sensitive

Answer 17

vascular

Question 18

Which CCB was the first clinically useful member of this class of drugs?

Answer 18

Verapamil

Question 19

Which CCB is from the dihydropyridine family of CCBs?

Answer 19

Nifedipine

Question 20

What is the MOA of CCBs?

Answer 20

Bind to the L-type calcium channel on the inside of the membrane reducing the frequency of opening in response to depolarization causing a marked decrease in transmembrane calcium influx

Question 21

How does the MOA of CCBs affect vascular smooth muscle?

Answer 21

leads to a long-lasting relaxation of vascular smooth muscle, vasodilation, and reduction in BP

Question 22

How does the MOA of CCBs affect cardiac muscle?

Answer 22

leads to a reduction in contractility, LV wall stress, SA node rate, and AV node conduction velocity leading to a reduction in myocardial oxygen requirements

Question 23

Name the toxicities of CCBs

Answer 23

• Cardiac depression
• Cardiac arrest
• Bradycardia
• AV block
• Heart failure

Question 24

Reflex tachycardia in response to hypotension occurs more often with

Answer 24

Nifedipine

Question 25

Which CCBs cause significant myocardial depression and exhibit an antiarrhythmic effect?

Answer 25

Verapamil | Diltiazem

Question 26

Patients who are taking ___________ are more sensitive to the cardiodepressant effects of CCBs

Answer 26

beta-blockers

Question 27

What is the MOA of Beta-blockers in the management of angina?

Answer 27

decrease myocardial oxygen requirements, both at rest and during exercise, by decreasing heart rate, BP, and contractility

Question 28

Are beta-blockers vasodilators?

Answer 28

no

Question 29

Undesirable effects of the Beta-blockers in angina include a(n) (increase or decrease?) in diastolic volume, which is associated with a(n) (increase or decrease?) in myocardial oxygen requirements

Answer 29

increase; increase

Question 30

What are some contraindications of beta-blockers?

Answer 30

- Asthma and other bronchospastic conditions - Severe bradycardia - AV blockade - Severe left ventricular failure

Question 31

The undesirable effects of the beta-blockers can be balanced by the concomitant use of

Answer 31

nitrates

Question 32

What is the indication of Ranolazine?

Answer 32

treatment of chronic angina in patients who have not achieved an adequate response with other antianginal drugs and have no other treatment alternatives

Question 33

Which drugs are contraindicated with the use of Ranolazine?

Answer 33

Diltiazem | Verapamil

Question 34

What is the MOA of Ranolazine?

Answer 34

Inhibits the late inward sodium current leading to reduction in intracellular calcium sodium levels, reversal of calcium overload, restoration of ventricular pump function, and prevention of ischemia-induced arrhythmias

Question 35

Name the toxicities of Ranolazine

Answer 35

- Prolonged QT interval - Constipation - Nausea - Dizziness

Question 36

Ranolazine is a substrate for

Answer 36

CYP3A4

Question 37

Ranolazine should not be used with inhibitors of CYP3A4, which could (increase or decrease?) its serum concentrations and QTc interval prolongation

Answer 37

increase

Question 38

True of False: Ranolazine is contraindicated in patients with QT prolongation or hepatic impairment?

Answer 38

True

Question 39

What type of drugs are contraindicated with the use of Ranolazine?

Answer 39

drugs that prolong the QTc interval