Anti anginal Agents

Question 1

What are the drug classes used for relief of anginal pain?

Answer 1

Beta 1 blockers
Calcium channel blockers
Organic nitrates
Sodium channel blocking drug

Question 2

What beta one selective agents are used in angina? When are they used?

Answer 2

Initial anginal therapy , helps reduce risk of death and MI in patients with prior history.
Metoprolol (Lopressor)- more effective
Atenolol (Tenomin)

Question 3

What is the mechanism of action of beta one selective blockers?

Answer 3

*Decrease oxygen demands of the myocardium by blocking beta one receptors.
*Decreases heart rate, contractility, cardiac output, and blood pressure

Question 4

What are the contraindications of beta one selective blockers?

Answer 4

• Severe bronchospasm
  *Vasospastic angina
  *Bradycardia

Question 5

What calcium channel blockers are used with angina? When are they used?

Answer 5

Effort and vasospastic angina
*Amlodipine
*Felodipine
*Verapamil
*Nifedipine
*Diltiazem

Question 6

What is the mechanism of action of calcium channel blockers?

Answer 6

*Inhibit entrance of calcium into cardiac and smooth muscle cells of the coronary and systemic arterial beds.
*Dilate arteriales, causing decrease in smooth muscle tone and vascular resistance. Decreases afterload.

Question 7

Calcium channel blocker contraindications

Answer 7

• pre-existing conduction disorders
  *symptomatic hypotension
  *acute coronary syndrome
  *Grapefruit juice

Question 8

Calcium channel blocker side effects

Answer 8

*Lightheadedness
*Low blood pressure
*Slower heart rate
*Constipation
*Swelling in feet and ankles
*heart block
*acute heart failure

Question 9

Dihydropyridines calcium channel blocker meds and effects

Answer 9

• Amlodipine, nifedipine, felodipine
  *potent vasodilator effects
  *do not alter conduction through AV node

Question 10

Non-dihydropyridines calcium channel blockers meds and effects.

Answer 10

Verapamil, diltiazem
*decreases HR, slows AV nodal conduction
*Could produce /worsen heart block, could worsen heart failure
* Benefits in patient with atrial tachyarrhythmia

Question 11

What medication class is NOT recommended in heart failure?

Answer 11

Calcium channel blockers

Question 12

What organic nitrates are used in angina? What types of angina?

Answer 12

*Effort, vasospastic, and unstable angina
*Isosorbide mono nitrate (Imgur)-Daily preventative
*Nitroglycerin (Nitrostat, nitrolingual)-Used as needed for anginal attacks
*Isosorbide denigrate (Isordil)-prophylactic

Question 13

What is the MOA of organic nitrates?

Answer 13

*Venous dilation-Reduces preload and myocardial wall tension, decreases oxygen requirements
*Reduction of arteriolar resistance-Reduces afterload, decreases oxygen demand

Question 14

Contraindications of organic nitrates

Answer 14

• Severe anemia
  *Increased intracranial pressure
  *Circulatory failure and shock

Question 15

Organic nitrates side effects

Answer 15

*headaches
* dizziness
*lightheadedness
*nausea
*flushing
*low BP

Question 16

What is the name of the sodium channel blockers used in angina and what is the MOA, uses, and risks?

Answer 16

*Ranolazine
*Inhibits the late phase of sodium current improving oxygen supply and demand
*improves diastolic function
* anti anginal and antiarrhythmic, used when other medications have failed
* Risk of drug interactions and can prolong QT interval.

Question 17

What medications do you have to express caution in when co-prescribing with a beta blocker and why?

Answer 17

Diltiazem and verapamil as this combination has additive effects on the sinus and AV nodes.

Question 18

Why is the combination of nitrates and sildenafil (viagra, Revatio) potentially dangerous?

Answer 18

Both medications cause vasodilation and coadministration leads to lowering of blood pressure and blood flow that can precipitate a heart attack