Anti-Anginal Drugs

Question 1

what results in myocardial ischemia?

Answer 1

imbalance between oxygen supply and demand

Question 2

what are 2 things that can cause decrease of oxygen/blood supply?

Answer 2

1. plaques obstruct perfusion
2. coronary artery spasm

Question 3

what can coronary artery spasm cause?

Answer 3

prinzmetal / vasospastic / rest angina

Question 4

what can cause an increase in oxygen/blood demand?

Answer 4

exertion/stress

Question 5

what is stable/typical angina also called?

Answer 5

coronary artery disease

Question 6

how is typical angina usually managed?

Answer 6

lifestyle changes and medications

Question 7

what is unstable angina also called?

Answer 7

acute coronary syndrome (ACS)

Question 8

what is unstable angina caused by?

Answer 8

ruptured plaque with platelet aggregation and thrombi formation

Question 9

what does angina with increased pain severity, frequency, duration, and occurrence at a lower exercise level indicate?

Answer 9

patient is progressing from stable to unstable angina

Question 10

what is used to prevent ischemic heart disease?

Answer 10

statins

Question 11

what two variables determine oxygen supply?

Answer 11

1. arterial oxygen content
2. coronary blood flow

Question 12

what four variables determine oxygen demand?

Answer 12

1. increased HR
2. increased contractility
3. increased preload
4. increased afterload

Question 13

amount of blood in the ventricle during diastole

Answer 13

preload

Question 14

resistance the heart has to pump against to push blood into systemic circulation

Answer 14

afterload

Question 15

what will an increase in one or all of HR, contractility, preload, and/or afterload cause?

Answer 15

increased demand

Question 16

what is the cardinal symptom of angina?

Answer 16

squeezing pain in center of chest that lasts more than a few minutes

Question 17

what are the classic symptoms of angina? (7)

Answer 17

1. pain to arms, neck, jaw, shoulder or back
2. SOB
3. diaphoresis
4. dizziness, fainting
5. anxiety
6. nausea
7. fatigue

Question 18

what is the primary function of nitric oxide?

Answer 18

dilates blood vessels

Question 19

what does nitrate combine with to be reduced to nitric oxide?

Answer 19

sulfhydryl (SH)

Question 20

where is sulfhydryl found?

Answer 20

endogenously

Question 21

what is myocardial oxygen consumption (MVO2)?

Answer 21

the amount of oxygen used by the heart

Question 22

when active nitric oxide dilates coronary arteries and veins at low doses, what does is cause?

Answer 22

decreased preload

Question 23

when active nitric oxide dilates large arteries and arterioles at high doses, what does it causes?

Answer 23

decreased TPR, afterload, and MVO2

Question 24

how does cGMP affect contractility?

Answer 24

it does not let calcium into the muscle = decreases contractility

Question 25

what does the activation of nitrate to nitric oxide lead to?

Answer 25

activation of guanylyl cyclase to create cGMP

Question 26

how can nitroglycerine be administered? (2)

Answer 26

1. sublingual 2. buccal

Question 27

what is the onset of sublingual or buccal nitroglycerine?

Answer 27

2-4 mins

Question 28

what is the duration of action of sublingual or buccal nitroglycerine?

Answer 28

1 hour

Question 29

if a patient with chest pain is given NTG SL x1 and pain is not relieved within 5 minutes, what does this suggest?

Answer 29

unstable angina

Question 30

how should NTG be administered for acute MI?

Answer 30

IV infusion

Question 31

what is the duration of action for prophylactic NTG administered via ointment?

Answer 31

4-8 hours

Question 32

what is the duration of action for prophylactic NTG administered via patch?

Answer 32

24 hours

Question 33

how should isosorbides be administered?

Answer 33

PO

Question 34

which isosorbide is the active form?

Answer 34

isosorbide mononitrate

Question 35

how does tolerance to nitrate develop?

Answer 35

chronic exposure

Question 36

in the tolerance to nitrate, how is there a decreased capacity of vascular smooth muscle to convert nitrates to nitric oxide?

Answer 36

used up sulphydryl groups in the body

Question 37

how can tolerance to nitrate be overcome?

Answer 37

short periods (8-12hrs/day) of nitrate absence from the body

Question 38

what causes the adverse effect of SL NTG of postural hypotension?

Answer 38

rapid drop in BP and sudden movement

Question 39

what causes reflex tachycardia as an adverse effect of NTG?

Answer 39

compensation of drop in BP - heart pumps quicker

Question 40

what causes the flushing and headaches as an adverse effect of NTG?

Answer 40

vasodilation of all vessels in the body

Question 41

what administration route of NTG is most likely to cause a rash?

Answer 41

transdermal NTG

Question 42

why is it important to give NTG sublingual?

Answer 42

avoid extensive first-pass effect by hepatic nitrate reductase

Question 43

which type of nitrite is less effected by first pass effect and is therefore given PO?

Answer 43

isosorbide dinitrate

Question 44

what does PDE V do?

Answer 44

inactivates cGMP

Question 45

what does PDE V inhibitor do?

Answer 45

inhibits the inactivation of cGMP, which leads to increased cGMP

Question 46

what does cGMP do?

Answer 46

stimulates smooth muscle relaxation = decreased BP

Question 47

why shouldn't sildenafil (PDE V inhibitor) be given to a patient taking an organic nitrate?

Answer 47

can cause prolonged hypotension

Question 48

what do beta 1 and beta 2 blockers do?

Answer 48

block sympathetic nervous system

Question 49

where are beta 1 receptors present on? (2)

Answer 49

juxtaglomerular cells in kidney heart

Question 50

what would a beta 1 blocker do? (3)

Answer 50

1. block renin release 2. decrease angiotensin II 3. decrease afterload

Question 51

what are beta 1 blockers typically used for? (2)

Answer 51

1. hypertension 2. heart failure

Question 52

where are beta 2 receptors typically located?

Answer 52

smooth muscle cells on heart, lungs, and liver

Question 53

what does activation of beta 1 receptor cause? (5)

Answer 53

1. increased HR 2. increased contractility 3. increased CO 4. increased renin 5 increased angiotensin II

Question 54

what does blocking of the beta 1 receptor cause? (4)

Answer 54

1. decreased HR 2. decreased CO 3. decreased afterload 4. decreased angiotensin II

Question 55

what does blocking of beta 1 receptors mask?

Answer 55

hypoglycemia

Question 56

what does activation of beta 2 receptors cause? (5)

Answer 56

1. bronchodilation 2. vasodilation 3. skeletal m tremor 4. hepatic glycogenolysis 5. gluconeogenesis (increased BG)

Question 57

what does blocking of beta 2 receptors cause? (2)

Answer 57

1. bronchoconstriction 2. hypoglycemia

Question 58

if a patient comes in to the clinic to reverse the blockade of beta 2 receptors, what are they at risk for?

Answer 58

acute hypertension with too much vasopressors

Question 59

what does it mean when some beta blockers have membrane stabilizing activity?

Answer 59

they can inhibit action potential in cardiac cells

Question 60

what can beta blockers with intrinsic sympathomimetic activity (ISA) do?

Answer 60

partially activate receptor

Question 61

what is not a good choice for patients with angina?

Answer 61

beta blockers with intrinsic sympathomimetic activity (ISA)

Question 62

which organ metabolizes and eliminates lipid soluble medications?

Answer 62

liver

Question 63

which two beta blockers are generation 1 (nonselective)?

Answer 63

propranolol sotalol

Question 64

what receptors do generation 1 (propranolol) beta blockers work on?

Answer 64

beta 1 and beta 2 receptors

Question 65

which receptors do generation 2 beta blockers work on?

Answer 65

beta 1 (selective)

Question 66

which 3 beta blockers are generation 2? (beta 1 selective)

Answer 66

atenolol metoprolol acebutolol

Question 67

what are bad effects of generation 1 and 2 beta blockers? (2)

Answer 67

increase triglycerides decrease HDL

Question 68

what receptors do generation 3 beta blockers work on?

Answer 68

alpha 1 receptors

Question 69

what 3 alpha blockers are generation 3?

Answer 69

carvedilol labetalol nebivolol

Question 70

which medication is used in hypertensive emergency?

Answer 70

labetalol

Question 71

what is the main function of generation 3 alpha 1 blockers? (2)

Answer 71

peripheral vasodilation better decrease in BP

Question 72

what are beta blockers not effective for? (2)

Answer 72

1. coronary artery spasm 2. exertion-induced angina

Question 73

why are beta blockers combines with nitrates?

Answer 73

antagonize SNS activity

Question 74

what should be avoided in beta blockers?

Answer 74

those with intrinsic sympathomimetic activity

Question 75

what can abrupt withdrawal of long-term beta blockers lead to? (2)

Answer 75

unstable angina MI

Question 76

what do calcium channel blockers bind to?

Answer 76

L-type Ca channels

Question 77

what do CCBs cause?

Answer 77

peripheral and coronary vasodilation

Question 78

what do CCBs decrease? (2)

Answer 78

afterload MVO2

Question 79

what are 2 non-dihydropyridines CCBs?

Answer 79

verapamil ditiazem

Question 80

what do NDHP CCBs decrease?

Answer 80

HR CO (myocardial contractility) conduction in SA and AV nodes

Question 81

what do NDHP CCBs work on?

Answer 81

the heart

Question 82

what are NDHP CCBs used for? (2)

Answer 82

angina and arrhythmias

Question 83

what type of antianginal is contraindicated in patients with heart failure?

Answer 83

NDHP CCBs

Question 84

what are 5 dihydropyridines CCBs?

Answer 84

Nifedipine Isradipine Nicardipine Felodipine Amlodipine

Question 85

what do DHP CCBs cause?

Answer 85

peripheral vasodilation

Question 86

what is a side effect of DHP CCBs?

Answer 86

reflex tachycardia

Question 87

what are DHP CCBs used for?

Answer 87

hypertension