Anti-anginal drugs Flashcards Preview

Pharm block 4 hemostasis and cardiac > Anti-anginal drugs > Flashcards

Flashcards in Anti-anginal drugs Deck (32)
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1

drug therapy options for exertional angina

Nitrates
Calcium Channel Blockers
Beta Blockers
Ranolazine
Ivabradine

2

how do nitrates work in SMC

Activates Guanylyl Cyclase
Increases cGMP
Dephosphorylates Myosin Light Chains
Ultimately Produces Smooth Muscle Relaxation
Relaxation Is ENDOTHELIUM-INDEPENDENT

3

NITRATE MECHANISM OF ACTION

• DECREASED VENOUS RETURN
Dilates Venous Capacitance Vessels
• REDUCED LV WALL TENSION
LaPlace’s Law
• REDUCED AFTERLOAD
• DIRECT CORONARY ARTERY VASODILATATION
Increased Subendocardial Perfusion

4

CLINICAL USE OF ORGANIC NITRATES

Angina Pectoris
Exertional Angina
Unstable Angina
Prinzmetal’s Angina
Hypertensive Emergencies
Congestive Heart Failure

5

MOST COMMONLY USED ORGANIC NITRATES FOR ANGINA

Nitroglycerine (sublingual, spray, patch or ointment)

Isosorbide mono/dinitrate (sublingual, chewable, oral)

6

nitrate side effects

orthostatic hypotension
reflex tachycardia
headache

nitrate tolerance (cannot be given 24/7)

7

what type of channel regulates smooth muscle contracton

voltage gated L-type Ca channels

8

what type of channel regulates cardiac muscle contration

voltage gated L-type Ca channels - in cardiac cells the amount of Ca that enters is proportional to the strength of contraction

9

what type of channel regulates cardiac pacemaker activity

L-type Ca channels

10

CLINICAL USE OF CALCIUM CHANNEL BLOCKERS (6)

Angina Pectoris
Hypertension
Arrhythmias
Hypertrophic Cardiomyopathy
Migraine
Raynaud’s Phenomenon

11

CALCIUM CHANNEL BLOCKERS FOR ANGINA exampes

DIHYDROPYRIDINES
Nifedipine
Nicardipine
Amlodipine

VERAPAMIL
DILTIAZEM
BEPRIDIL

12

nifedipine has mainly what type of effect

vasodilatory (very little negative inotrophic and chronotropic effects)

13

side effects of Verapamil and diltiazem (CCB)

bradycardia
CHF
heart block
hypotension

14

side effects of nifedipine

reflex tachycardia
peripheral edema (a little usually means the drug is working and will go away)
hypotension

15

where are B1 and B2 receptors found?

β1 Receptors:
Cardiac Muscle

β2 Receptors:
Cardiac Muscle
Bronchial Smooth Muscle
Vascular Smooth Muscle

16

cAMP ACTIONS 
IN CARDIAC MUSCLE

• Increased Opening of L-type Ca channels
Inotropy
• Increased Reuptake of Ca into SR stores
Inotropy & Lusitropy
• Increased Pacemaker Current
Chronotropy
• Increased Rate of Conduction
Dromotropy

17

B-blockers effects on the heart

block cAMP effects:
• decrease HR
• decrease afterload
• increase heart size
• decrease contractility
• decrease O2 wastage
* anti-arrhythmic
• increased diastolic perfusion
• decrease O2 demand

18

CLINICAL USE OF BETA BLOCKING AGENTS (8)

Angina Pectoris
Hypertension
Arrhythmias
Dissecting Aortic Aneurysm
Mitral Valve Prolapse
Post-MI Prophylaxis
Hyperthyroidism
Migraine

19

NONSELECTIVE (BETA-1+BETA-2) BBs

PROPRANOLOL
NADOLOL

20

CARDIOSELECTIVE (BETA-1) BB

ATENOLOL
METOPROLOL

21

NONSELECTIVE WITH ISA

LABETALOL
PINDOLOL

22

CARDIOSELECTIVE WITH ISA

ACEBUTOLOL

23

BB primarily eliminated by the liver

Propranolol, Caredilol, Metoprolol

24

BB primarily eliminated by the kidney

Atenolol, Nadolol, Sotalol

25

BETA BLOCKER SIDE-EFFECTS

BRONCHOSPASM* (do not give if pt has obstructive pulmonary disease)
PERIPHERAL VASOSPASM
EXAGGERATION OF CARDIAC THERAPEUTIC EFFECTS

CNS EFFECTS
INSOMNIA
DEPRESSION
FATIGUE

26

CONTRAINDICATIONS TO ADMINISTRATION OF BETA BLOCKERS

Acute Congestive Heart Failure
Marked bradycardia (HR

27

RANOLAZINE - suggested MOA

Ranolazine partially inhibits fatty acid oxidation, allowing the heart to use more glucose as a fuel by relieving the inhibition on pyruvate dehydrogenase.

The net result is reduced lactic acid accumulation, less intracellular acidosis, and a reduction in the severity of the myocardial ischemic response.

28

IVABRADINE MOA

Ivabradine is an If Current Inhibitor (The “funny” current) responsible for Phase IV depolarization of the SA node.
Inhibits pacemaker activity and slows the heart rate at rest and during exercise

29

who is Ivabradine recommended for?

Indicated for the symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm who cannot take beta blockers.

Also indicated in combination with beta blockers in heart failure patients with LVEF lower than 35 percent inadequately controlled by beta blockers alone and whose heart rate exceeds 70 beats per minute.

30

how effective is ivabradine

As effective as beta blockers and comparable with amlodopine in the management of chronic stable angina