Anti-Anginals

Question 1

What are the types of angina

Answer 1

Stable
Unstable
Variant (Prinzmetal)

Question 2

What are the classes of angina

Answer 2

0-4

Question 3

What is the only Tx rationale that works for Prinzmetal

Answer 3

Decrease O2 demand

Question 4

What are the organic nitrates used for Angina

Answer 4

Isosorbide mononitrate
Isosorbide dinitrate
Nitroglycerin
Sodium nitroprusside

Question 5

What beta blockers are used for Angina

Answer 5

Acebutolol
Atenolol
Metoprolol
Propranolol

Question 6

What Ca channel blockers are used for Angina

Answer 6

Amlodipine
Fenoldipine
Verapamil
Diltiazem

Question 7

What Na channel blocker is used for Angina

Answer 7

Ranolazine

Question 8

Which antianginals mimic NO

Answer 8

Organic nitrates

Question 9

Which cause a rapid reduction in myocardial O2 demand

Answer 9

Organic nitrates

Question 10

Mechanism of organic nitrates

Answer 10

Activate guanylyl cyclase
SM relaxation
Decrease coronary vasoconstriction
Veinous dilation

Question 11

Which is used as oral angina prophylaxis

Answer 11

Isosorbide mononitrate

Question 12

What do you use for an ongoing angina attack

Answer 12

Isosorbide dinitrate

Question 13

What is given sublingual as 1st line Tx for acute angina Sx

Answer 13

Nitroglycerin

Question 14

What is given in unstable angina and HF

Answer 14

IV Nitroglycerine

Question 15

What is used for angina in emergency

Answer 15

Sodium nitroprusside

Question 16

Longer duration than Nitroglycerine

Answer 16

Isosorbide mononitrate

Isosorbide dinitrate

Question 17

How is nitrate tolerance/desensitization overcome

Answer 17

Nitrate free interval (10-12hrs)

Question 18

Nitrate contraindication

Answer 18

Pt on Sidenafil

Sidenafil inhibits PDE5 = too much cGMP

Question 19

Which nitrate can cause CN poisoning

Answer 19

Sodium nitroprusside

Question 20

Which beta blocker is not cardioselective

Answer 20

Propranolol

Question 21

Which beta blockers are beta 1 cardioselective

Answer 21

Metoprolol

Atenolol

Question 22

Main mechanism of beta blockers in angina

Answer 22

Decrease O2 load
Decrease freq/severity of attacks
Decrease HR, contractility

Question 23

Who do you give beta blockers for angina

Answer 23

Stable angina with LV dysfunction

Question 24

What happens if you rapidly remove beta blocker

Answer 24

Rebound HTN

Question 25

Contraindications for beta blockers in angina

Answer 25

Prinzmetal Asthma/COPD Diabetes, PVD Severe bradycardia

Question 26

DOC for variant angina

Answer 26

Ca channel blockers

Question 27

When do you use ca channel blockers

Answer 27

Beta blockers don't work, or contraindicated

Question 28

How do Ca channel blockers work

Answer 28

Coronary, peripheral vasodilation | Reduce contractility

Question 29

Which Ca channel blockers have minimal effect on conduction or HR

Answer 29

Amlodipine Felodipine Block Ca entry, decrease BP

Question 30

Which Ca channel blockers slow AV conduction directly

Answer 30

Verapamil | Diltiazem (less HR decrease)

Question 31

Main AE of Ca channel blockers

Answer 31

Constipation

Question 32

Contraindication for Diltiazem/Verapamil

Answer 32

Pre-existing depressed cardiac function | AV conduction abnormality

Question 33

Caution for Verapamil in patients on what

Answer 33

Digoxin

Question 34

What does the Na/Ca exchanger do in ischemia

Answer 34

Reverses direction

Question 35

What does Ranolazine do

Answer 35

Block the Na/Ca exchanger, indirectly lowering Ca levels

Question 36

How does Ranolazine treat angina

Answer 36

Decrease contractility Decrease O2 demand Modify FA oxidation

Question 37

What is Ranolazine prophylactic for

Answer 37

Angina when all other failed

Question 38

What metabolizes Ranolazine

Answer 38

3A4

Question 39

AE for Ranolazine

Answer 39

QT prolongation Nausea, constipation Dizziness

Question 40

Acute attack Tx for Stable/Unstable

Answer 40

Nitroglycerin

Question 41

Maintenance therapy for Stable/Unstable

Answer 41

``` Long acting nitrates Beta Blockers (Ca channel blockers if ineffective) ```

Question 42

Last ditch therapy for Stable/Unstable

Answer 42

Ranolazine

Question 43

Nitrate half lives shortest to longest

Answer 43

Sodium Nitroprusside Nitroglycerine Isosorbide dinitrate Isosorbide mononitrate

Question 44

Tx for Prinzmetal Sx only

Answer 44

Nitroglycerin | Ca channel blockers (any)