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Pharmacology > Anti Anginals > Flashcards

Anti Anginals Flashcards

1
Q

three types of angina

A

chronic stable
unstable
prinzmetal (variant)

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

what is prinzmetal variant angina caused by

A

coronary spasm which temporarily reduces coronary blood flow

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5
Q

short term and long term goals of antianginal therapy

A

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

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6
Q

what does angina result from

A

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

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7
Q

drugs used to treat angina

A
  • 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
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8
Q

what are the calcium channel blockers

A 
VAND
verapamil
amlodipine
nifedipine
diltiazem
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9
Q

what are calcium channel blockers used to treat

A
  • hypertension, angina, and arrythmias

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

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10
Q

what are used in combination with dihydropyridines and why

A

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

also used if beta blockers are contraindicated

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11
Q

what are the anti-anginal effects of CCBs

A

increased vasodilation –> increased oxygen supply

cardiodepressant –> reduce oxygen demand

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12
Q

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

A

reverse coronary vasospasm that occurs in prinzmetal variant angina

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13
Q

adverse effects of calcium channel blockers

A
  • 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
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14
Q

contraindications for CCBs

A

bradycardia, conduction defects, heart failure

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15
Q

nitrates used to treat angina

A

isosorbide dinitrate
isosorbide mononitrate
nitroglycerin
sodium nitroprusside

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16
Q

clinical application of nitrates (name them again)

A

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
Q

mechanism of nitrates

A

they work via NO

  • relax vascular smooth muscle (vasodilation)
  • inhibit platelet aggregation (anti-thrombotic)
  • inhibiting leukocyte endothelial interactions (anti-inflammatory)
18
Q

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

A

vessels become desensitized to the vasodilatory effects of nitrates

overcome by infrequent dosing with smallest amount possible

19
Q

of all the nitrates which has longest half life and importance

A

isosorbide dinitrate and mononitrate

impo because it can be used for long term therapy

20
Q

adverse effects of nitrates

A 
hypotension
reflex tachycardia
headache (cerebral vasodilation)
facial flushing
nitroprusside - cyanide toxicity
21
Q

contraindication of nitrates and why

A

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

22
Q

beta blockers used for anginas

A

MAP
metoprolol
atenolol
propanolol

23
Q

clinical use of beta blockers in angina

A

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

24
Q

what are the anti anginal effects attributed to beta blockers

A

they reduce workload of the heart hence decreasing oxygen demand

25
Q

adverse effects of beta blockers

A
  • 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
Q

contraindications for beta blockers

A
  • 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
Q

what is ranolazine used

A

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

28
Q

mechanism of action for ranolazine

A

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
Q

adverse effects of ranozaline

A 
QT prolongation (increases ventricular depolarization)
nausea, vomiting, dizziness, constipation
30
Q

contraindication of ranozaline

A

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

31
Q

treatment of acute attack of stable angina

A

nitroglycerin or rest

32
Q

maintenance therapy for stable angina

A
  • 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
Q

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

A

nitroglycerin or rest

34
Q

long term maintenance of unstable angina

A

nitroglycerin and beta blockers

35
Q

drug used for symptomatic treatment of variant prinzmetal angina

A

nitroglycerin and calcium channel blockers

Pharmacology (79 decks)

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