Anti-Anginal Agents I Flashcards Preview

CV II Exam 3 > Anti-Anginal Agents I > Flashcards

Flashcards in Anti-Anginal Agents I Deck (51):
1

isosorbide dinitrate

nitrate vasodilator

2

nitroglycerin

nitrate vasodilator

3

non-DHP CCB

verapamil and diltiazem

4

DHP CCB

nifedipine
amlodipine
felodipine

5

-dipines

DHP CCBs

6

clopidogrel

antiplatelet

7

aspirin

antiplatlet

8

heparin

anticoag

9

IIa IIIb inhibitors

abciximab
tirofiban
eptifibatide

10

angina pectoris

Sx of IHD

CAD usually the cause

11

heavy pressing substernal discomfort
-radiates to left shoulder, jaw

sensation of angina

12

typical angina

exertional
-induced by exercise and relieved by rest and/or nitroglycerin

ST segment depression

13

atypical angina

at rest

coronary vasospasm episodically reduced coronary flow

transient ST segment elevation

14

prinzmetal

vasospasm

15

unstable angina

rupture of plaque

abrupt decrease in flow

Sx not relieved by 3 nitro in 15 minutes - call 911

16

angina

loss of O2 supply and demand balance

17

agents that decrease O2 demand

beta blockers
CCBs

18

approach to typical angina

decrease O2 demand

-beta-blocker and aspirin
-or clopidogrel if ASA contraindicated

-beta-blocker and aspirin and long acting nitrate
-sub-lingual nitro - acute attacks

-ACE inhibitors - patients with DM or left vent dysfunction

-long acting CCB - DHPs - if beta blocker contraindicated

19

approach to unstable angina

MONA
-morphine, O2, nitro, ASA

and beta blocker or non-DHP CCB if beta blocker CI'd and no LV dysfunction

PCI
CBG
thrombolytics

20

avoid non-DHP CCB and beta blocker

can cause heart block

21

organic nitrates

prodrugs sources of NO
-decrease preload and afterload

mainly - large veins - decreased preload

also dilate coronary arteries (subendocardial region)

22

mechanism of NTG

increased guanylyl cyclase and cGMP
-leads to de-P of myosin and relaxation of smooth muscle**

23

isosorbide dinitrate

long acting nitrate vasodilator

24

adverse effect of nitrates

headaches, facial flush, dizziness, orthostatic hypotension (alcohol worsens)

25

tolerance of nitrates

effectiveness diminishes significantly with continued use

need to go 8hr drug-free/day

26

patients on erectile dysfunction drugs

contraindicated use of nitrates

sildenafil, tadalafil, vardenafil, cyclic nucleotide

27

right ventricular infarction

contraindication for nitrates

28

verapamil

non-DHP CCB

-cardiac effects

29

diltiazem

non-DHP CCB

-cardiac effects

30

DHPs

CCB with predominant vasodilation effects

nifedipine, amlodipine, felodipine

initial vasodilation with reflex tachycardia

31

CCBs in angina

block Ca entry through L-type Ca channels (slow)

relax arteriolar smooth m
-decreased afterload and decreased O2 demand**

32

relaxation of arterioles and decreased arterload

affect of CCBs

33

cardiac cells

fast channels - Na
slow channels - Ca

Ca induces additional SR Ca release

binds troponin - allows contraction

CCB - negative inotropic effect - concurrent decrease in vascular resistance

34

DHPs

block channels but don't effect recovery of channels
-not frequency dependent

35

non-DHPs

block channels, delay recovery, and are frequency dependent

decrease rate of SA node depolarization and slow AV node conduction

useful for supraventricular tachyarrhythmias

36

supraventricular tachyarrhythmias

non-DHP CCBs

37

all CCBs

decrease coronary vascular resistance and increase coronary blood flow

38

DHP

slower onset, longer acting drugs

39

non-DHP and betablocker

contraindicated
-potential for AV block**

40

CCBs and angina

can result in coronary steal

41

constipation

verapamil

42

mild to moderate exertional angina

beta blockers

43

post MI

beta blockers should be used in every patient

44

chronic stable angina

beta blocker with long acting nitrate or DHP CCB

45

aspirin

decreased mortality in patients with unstable angina
-reduced incidence of MI and death
-inhibition of platelet aggreation

46

aspirin mechanism

blocks prostaglandin synthesis
-irreversible** inhibition of cyclooxygenase

47

clopidogrel

inhibits binding of ADP to platelet receptor
-irreversible inhibition of platelet aggregation

unstable angina, prophylaxis and treatment of TIA and completed stroke

standard treatment for patients undergoing stent placement

48

abciximab

IIb/IIIa antibody
-inhibits platelet aggregation

for Tx of unstable angina when angioplasty and atherectomy planned within 24 hours

49

prophylaxis and single attack angina

NTG - 1-3min onset and duration of 20-30min

50

chronic stable angina

beta blockers, CCBs, long duration nitrates

51

vasospastic angina

CCB or nitrates