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Flashcards in Anti Anginals Deck (35):
1

three types of angina

chronic stable
unstable
prinzmetal (variant)

2

what is chronic stable angina caused by and what does it lead to

chronic narrowing of coronary arteries due to atherosclerosis leading to increased oxygen demand --> pain with a predictable threshold of physical activity

3

what is unstable angina caused by and what does it lead to

transient formation and dissolution of a blood clot within a coronary artery due to an atherosclerotic plaque rupture --> reduction in oxygen supply

4

what is prinzmetal variant angina caused by

coronary spasm which temporarily reduces coronary blood flow

5

short term and long term goals of antianginal therapy

short term: reduce or prevent anginal symptoms that limit exercise capability and quality of life

long term: prevent MI, arrhythmias, heart failure, and extend pt's life

6

what does angina result from

reduction in oxygen supply/demand ratio hence anti anginals improve this ratio

7

drugs used to treat angina

- vasodilators (increase oxygen supply and decrease oxygen demand): calcium channel blockers and nitrates
- cardioinhibitory drugs (decrease oxygen demand): beta blockers and calcium channel blockers
- ranolazine: sodium channel blocker
- anti thrombotic drugs: anti coagulants and anti platelet drugs

8

what are the calcium channel blockers

VAND
verapamil
amlodipine
nifedipine
diltiazem

9

what are calcium channel blockers used to treat

-hypertension, angina, and arrythmias
-treats all three types of angina: chronic stable, unstable angina, prinzmetal angina

10

what are used in combination with dihydropyridines and why

beta blockers are used with amlodipine and nifedipine because of reflex tachycardia

also used if beta blockers are contraindicated

11

what are the anti-anginal effects of CCBs

increased vasodilation --> increased oxygen supply

cardiodepressant --> reduce oxygen demand

12

importance of CCB dilating the coronary arteries other than increasing oxygen supply

reverse coronary vasospasm that occurs in prinzmetal variant angina

13

adverse effects of calcium channel blockers

-dihydropyridines: reflex tachycardia, dizziness, flushing, headache, hypotension, constipation, and peripheral edema

-non-dihydropyridines: cardiac conduction abnormalities (bradycardia, AV block and heart failure), anorexia, nausea, hypotension, peripheral edema

14

contraindications for CCBs

bradycardia, conduction defects, heart failure

15

nitrates used to treat angina

isosorbide dinitrate
isosorbide mononitrate
nitroglycerin
sodium nitroprusside

16

clinical application of nitrates (name them again)

isosorbide dinitrate, isosorbide mononitrate, nitroglycerin, sodium nitroprusside

for stable, unstable, and variant

nitrogylcerin: first line for acute anginal symptx
nitroprusside: emergency and ICU settings
isosorbide mononitrate and dinitrate: prophylaxis

17

mechanism of nitrates

they work via NO
-relax vascular smooth muscle (vasodilation)
-inhibit platelet aggregation (anti-thrombotic)
-inhibiting leukocyte endothelial interactions (anti-inflammatory)

18

why does tolerance develop rapidly with nitrates and how is it overcome?

vessels become desensitized to the vasodilatory effects of nitrates

overcome by infrequent dosing with smallest amount possible

19

of all the nitrates which has longest half life and importance

isosorbide dinitrate and mononitrate

impo because it can be used for long term therapy

20

adverse effects of nitrates

hypotension
reflex tachycardia
headache (cerebral vasodilation)
facial flushing
nitroprusside - cyanide toxicity

21

contraindication of nitrates and why

sildenafil (cGMP dependent phosphodiesterase) used to tx erectile dysfunction --> inhibits breakdown of cGMP --> increase in plasma cGMP --> hypotension and impaired coronary perfusion

22

beta blockers used for anginas

MAP
metoprolol
atenolol
propanolol

23

clinical use of beta blockers in angina

pts with stable angina who have had ACS (acute coronary syndrome - STEMI, nonSTEMI) or who have left ventricular dysfunction

24

what are the anti anginal effects attributed to beta blockers

they reduce workload of the heart hence decreasing oxygen demand

25

adverse effects of beta blockers

-hypoglycemia
-bronchoconstriction
-CNS effects
-disturbed lipid metabolism
-CV effects: bradycardia, heart failure, hypotension, heart failure, reduced exercise capacity
-drug withdrawal: abrupt cessation can cause unstable angina, MI, or death due to upregulation of beta receptors during blockade

26

contraindications for beta blockers

-restrictive airway disease (COPD, asthma)
-sinus bradycardia and partial AV block
-heart failure
-variant angina: beta blockers reduce oxygen demand which cannot treat problem here which is reduced oxygen supply

27

what is ranolazine used

alternative option for pts with chronic angina that have failed all other therapies

28

mechanism of action for ranolazine

blocks sodium current which prevent calcium overload within the cell leading to improved coronary flow

typically Na late inward current lead to Ca inward current via the Na/Ca exchanger --> Ca leads to contraction of myocytes and impaired relaxation hence worsening the ischemia

29

adverse effects of ranozaline

QT prolongation (increases ventricular depolarization)
nausea, vomiting, dizziness, constipation

30

contraindication of ranozaline

pts with QT prolongation --> risk of torsades de pointes and ventricular arrhythmias

31

treatment of acute attack of stable angina

nitroglycerin or rest

32

maintenance therapy for stable angina

-long acting nitrates plus beta blockers are preferred
-CCBs when beta blocker not successful or contraindicated
-ranozaline when nitrates, beta blocker, and CCBs not successful

-aspirin and aggressive cardiovascular risk reduction should be part of maintenance therapy

33

tx for acute attack of unstable angina (usually occurs between stable angina and MI)

nitroglycerin or rest

34

long term maintenance of unstable angina

nitroglycerin and beta blockers

35

drug used for symptomatic treatment of variant prinzmetal angina

nitroglycerin and calcium channel blockers

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