Anti-Anginal

Question 1

Nitroglycerin and Isosorbide are what class of drugs?

Answer 1

Nitrates & Nitrites

Question 2

MOA for Nitrates, Nitrites?

Answer 2

Vasodilation via NO –> cGMP –> uneven vasodilation (veins > arterioles) –> decreased preload > afterload

Question 3

DOC for any acute anginal attack?

Answer 3

Nitroglycerin and Isosorbide.

Decreased myocardial O2 requirements

Question 4

T or F: nitrates relax all smooth muscles?

Answer 4

TRUE

Question 5

Why is sublingual the preferred form of Nitrates?

Answer 5

Avoids hepatic destruction (due to high first pass metabolism), rapid absorption, immediate relief

Question 6

Adverse effects of Nitrates/Nitrites?

Answer 6

Throbbing HA (vasodilation in brain) Tachycardia, Orthostatic hypotension

Question 7

IF you take nitro often, what will happen?

Answer 7

Tolerance or marked reduction to drugs effects

Question 8

T or F: Calcium channel blockers relax all smooth muscles that depend on calcium for normal resting tone and contraction?

Answer 8

TRUE

Question 9

Verapamil, Diltiazem, and Nifedipine are what drug class?

Answer 9

Ca Chanel Blockers

Question 10

Verapil has greater effect on vascular smooth muscle or cardiac muscle?

Answer 10

Cardiac muscle (depress SA/AV nodes)

Question 11

Niedipine has greater effect on vascular smooth muscle or cardiac muscle?

Answer 11

Vascular smooth muscle (cause vasodilation and reflex tachycardia)

Question 12

Why is Nifedipine indicated only in HTN, not angina?

Answer 12

May provoke angina attacks

Question 13

What anti-anginal class is better for chronic angina tx and not immediate angina relief?

Answer 13

Ca Channel Blockers

Question 14

What Ca channel blocker will have equal effects on vascular smooth muscle, cardiac muscle, vasodilation, reflex tachycardia, depression of SA/AV node function

Answer 14

Diltiazem

Question 15

Nifedipine can lead to what harmful effect?

Answer 15

Increased development of MI

rapid hypotension –> baroreflex –> increased cardiac workload –> ischmia

Question 16

Verapamil and diltiazem can lead to what harmful effect?

Answer 16

Serious cardiac depression (from SA/AV node depression)

Question 17

B-blockers have 3 CV effects on what 3 organs?

Answer 17

1. Heart (decrease CO)
2. Kidneys (decrease renin)
3. CNS (decrease sympathetic vasomotor tone

Question 18

How do B-blockers provide anginal relief?

Answer 18

Decrease sympathetic tone –> cardiac contractility –> myocardial O2 demand

Question 19

T or F: Beta agonists are ineffective in producing coronary vasodilation?

Answer 19

TRUE

Question 20

Bronchoconstriction, increased plasma TGs, decreased insulin, hypoglycemia response, and CNS side-effects are SE of what class of drugs?

Answer 20

B-blockers

Question 21

Why might B-blockers be harmful in tx of variant angina?

Answer 21

B/c slow HR and prolonged ejection will increase LV EDV and increase myocardial O2 requirement

Question 22

What is a new medication that is a last ditch effort for angina?

Answer 22

Ranolazine (works by a different mechanism, PFOX, inhibitor)

Question 23

What is the preferred tx for variant or angiospastic angina?

Answer 23

Nitrates and CCB

B-blocks will not dilate spastic coronary vessels

Question 24

Goals of anti-anginal therapy? (2)

Answer 24

Increase exercise tolerance

Decrease frequency and duration or myocardial ischemia

Question 25

What group of medications will have the best effect on tx of angina?

Answer 25

Various combos of 3 major drug classes

Question 26

What is the tx for Nitrate induced reflex tachycardia?

Answer 26

cardio specific CCB or B-blocker + vasodilator

Question 27

Most preferred drugs angina w/ concomitant for asthma?

Answer 27

CCB, nitrate or nitrite

Question 28

Most preferred drugs angina w/ concomitant for DM?

Answer 28

CCB, nitrate or nitrite

Question 29

Most preferred drugs angina w/ concomitant for HF?

Answer 29

Nitrate or nitrite

Question 30

Most preferred drugs angina w/ concomitant for HTN?

Answer 30

B-blocker, CCB

Question 31

Most preferred drugs angina w/ concomitant for peptic ulcer?

Answer 31

B-blocker, Nitrate or nitrite

Question 32

What drug is selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5)?

Answer 32

Sildenafil

Question 33

Sildenafil is used in the tx of what 2 diseases?

Answer 33

ED

Pulmonary HTN

Question 34

When is max concentration reached for Sildenafil?

Answer 34

3-120 minutes

Question 35

What is the half life of sildenafil?

Answer 35

4 hours

Question 36

What is Sildenafil metabolized by?

Answer 36

CYP3A4 > CYP2C9

Question 37

Visual impairments: transient blue color tinge to vision, photophobia, or blurred vision are SEs of what drug?

Answer 37

Sildenafil

Question 38

Sildenafil is contraindicated in what populations?

Answer 38

1. Pregnant
2. Lactating women
3. Infants/children
4. Current nitro use (any form, = increased vasodilation)
5. Current a-blocker use (= increased vasodilation)

Question 39

What juice should you avoid if taking Sildenafil?

Answer 39

Grapefuit

Question 40

What two drugs are more selective for PDE6 vs PDE5? What does this mean for SEs?

Answer 40

Vardenafil, Tadalfil

Decreased retinal sx (less blue tinge to vision)

Question 41

Will vardenafil allows for an erection sooner or later than if using sildenafil?

Answer 41

Sooner

V = “V”ery soon

Question 42

What ED medication allows for more spontaneity?

Answer 42

Tadalafil

(T = good for “T”omorrow

Question 43

Sildenafil, Tadalafil and Vardenafil are what class of drugs?

Answer 43

Phosphodiesterase type 5/6 inhibitors

Originally anti-anginal med, but more effective at tx ED