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Pharm2: Module 2 > Antianginal agents > Flashcards

Antianginal agents Flashcards

(76 cards)

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1
Q

what is angina pectoris

A

recurrent chest pain or discomfort when part/some of the heart does not get enough oxygen

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2
Q

where is angina pectoris located

A

Retrosternal or slightly to the left of Midline
occasionally limited to extra thoracic sites

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3
Q

where does angina pectoris radiate

A

neck, throat (‘choking’ sensation)
Jaw, teeth (‘toothache’)
left shoulder, arm (ulnar distribution)
epigastrium (heart burn)

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4
Q

a patient presents with new onset, increase in intensity, frequency or duration occurs at rest - what are you thinking

A

unstable angina or evolving acute MI

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5
Q

what is the quality and quantity (description) of angina

A

tightness, pressure, squeezing, heaviness, burning, aching, fullness
“heavy weight” or “band across my chest”
dull and deep

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6
Q

what is angina aggravated by

A

physical exertion
emotional stress
after eating heavy meals
environment
lying down

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7
Q

what is angina relieved by

A

rest
activity cessation
withdrawal of stressor
pharmacotherapy

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8
Q

What are alternative names for effort angina

A

“classic angina”
“Stable angina”

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9
Q

what is the presentation of effort angina

A

short lasting; heavy, burning, squeezing in chest
does not change - pattern stays the same
most common form

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10
Q

what is the cause of effort angina

A

inadequate blood flow in the presence of CAD
reduction of perfusion due to FIXED obstruction of coronary artery

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11
Q

what are the treatment options for effort angina

A

nitrates or rest

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12
Q

what are other names for vasospastic angina

A

variant angina
prinzmetal angina

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13
Q

what causes vasospastic angina

A

coronary artery spasm causing decreased blood flow of the heart muscle - uncommon patter, episodic

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14
Q

what are precipitators for vasospastic angina

A

occurs at rest, unrelated to physical activity, heart rate or blood pressure

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15
Q

what are the treatment options for vasospastic angina

A

coronary vasodilators (nitrates and CCB)

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16
Q

when does unstable angina occur

A

progressively less effort causes more increased frequency, duration and intensity of pain

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17
Q

what is the treatment for unstable angina

A

HOSPITAL ADMISSION, aggressive therapy to prevent progression to MI

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18
Q

what usually results from rupture of atherosclerotic plaque and partial/complete thrombosis of coronary artery

A

Acute Coronary Syndrome (ACS) - EMERGENCY
NSTEMI, STEMI, Unstable Angina

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19
Q

what causes an increase in biomarkers

A

necrosis of CV tissue

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20
Q

what are major determinants of cardiac oxygen consuption

A

wall stress/tension - IVP, ventricular radius (Volume), thickness
Heart rate
contractility

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21
Q

what is preload

A

initial stretchign of cardiac muscle cells proior to contraction
change affect ventricular stroke

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22
Q

what is afterload

A

force or load against which the heart contracts to eject the blood

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23
Q

what is contractility

A

strength of cardiac muscle

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24
Q

what changes and affects the force of contraction

A

change in preload

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25
what is the ventricular wall tension based on
thickness of the ventricular myocardium
26
what is the most important factor affecting myocardial oxygen demand
Heart rate
27
what increases heart oxygen consuption
increased heart rate
28
what is influenced by a variety of forces including calcium concentration
contractility
29
what is needed with more powerful contractions
more energy is needed
30
what are chronotropic drugs
changes in heart rate both positive and negative
31
what kind of drugs decrease heart rate
negative heart rate
32
what are inotropic drugs
alter the strength of the contraction of the heart Positive and negative
33
what strengthens the force of the heartbeat
positive inotropic drugs
34
what are anginal relief medication types
BB CCB nitrates sodium channel-blocking drug (ranolazine) interventional therapy
35
what are selective beta 1 blocker medicatiosn
Metoprolol Atenolol
36
what are calcium channel blockers
amlodipine felodipine nefidipine diltizaem verapamil
37
what are organic nitrates
isosorbide mononitrate nitroglycerin isosorbide dinitrates
38
what are b1 selective BB effective for
effort and unstable angina
39
what medicatiosn decrease oxygen demands on the myocardium which decreases the HR, contractility, CO and blood pressure
B1-adrenergic Beta Blockers
40
what are the contraindications for BB
severe bronchospasm - asthma vasospastic angina (ineffective and can make it worse) Bradycardia pindolol should be avoided in pts with prior MI/angina due to sympathominmetic effects
41
what are the side effects of BB medications
cold hands/feet fatigue nausea, weakness and dizziness dry mouth, skin and eyes weight gain
42
what is the recommended initial antianginal therapy
beta - adrenergic blockers
43
what are the effects of BB with patients with chronic renal disease
less effective - CCB/nitrates more effective
44
what can occur with abrupt discontinuation of BB
rebound angina, MI, HTN
45
what is metoprolol
cardioselective causes less bronchial constriction than propranolol extensively metabolized short half life (4-6 hrs)
46
what is atenolol
cardioselective not extensively metabolized and excreted primarily in urine half life 6 hours less effective than metoprolol in preventing complications of HTN
47
what are the CCB medications
effective in effort and vasospastic angina amlodipine felodeipine verapamil nifedipine diltiazem
48
what is the MOA for CCB
inhibits enterence of calcium into cardiac and smooth muscle cells of the coronary and systemic arterial beds dilates arterioles, causes decrease in smooth muscle tone and vascular resistance
49
what are contraindications for CCB
pre-existing conduction disorder symptomatic hypotension ACS grapefruit juice
50
what are the side effects of CCB
lightheadedness low BP slower HR constipation swelling in feet and ankles
51
what are the non-dihyrophyridine CCBs
Verapamil and diltiazam
52
what are the dihydrophyridine CCB
amlodipine nifedipine felodipine
53
what is amlodipine
dihydropyridine greater effect on smooth muscle in peripheral vasculature minimal effect on cardiac conduction second generation dihydropyridine derivative not recommended in pts with HF
54
what is felodipine
second generation dihydropyridine derivative not recommended in pts with HF
55
what is nifedipine
dihydropyridines treat vasospastic angina can increase HR; risk for tachycardia and increase O2 demand peripheral dilatory effects can decrease coronary perfusion
56
what are the side effects of Nefedipine
dizziness, lightheadedness, LE edema
57
what is diltiazem
non-dihydropyridine immediate in its actions monitor closely when using with other meds for angina as effects are additive monitor for bradyarrhythmias and heart block
58
what is verapamil
non-dihydropyridine mainly affects the myocardium greater negative inotropic effects than amlodipine monitor for bradyarrhythmias and heart block
59
what patients is verapamil not recommended for
pts with sick sinus syndrome, AV nodal disease or heart failure
60
what are the organic nitrates
isosorbide mononitrates nitroglycerin isosorbide dinitrates effects in effort, vasospastic and unstable angina
61
what is the MOA for nitrates
venous dilation - reduces preload and myocardial wall tension, decrease oxygen requirements (demand) reduction of arteriolar resistance - reduces afterload and decreases oxygen demand
62
what are the contraindications with nitrates
coadministration of PDE-5 inhibitors (viagra) severe anemia increased ICP circulatory failure and shock
63
what are the SE of nitrates
HA dizziness lightheadedness nausea flushing low BP
64
what is nitroglycerine
considered prototype drug administered sublingually usually treatment of anginal attacks fast onset of action stays in the body for short duration and broken down by liver
65
what is isosorbide mononitrate
taken daily for prevention of angina onset 60-120 min duration 5-12 hours
66
what is isosorbide dinitrate
sublingual tablet or immediate release prophylaxis for acute angina sublingual: onset 2-5min; duration 1-2 hours immediate release: onset 20-40 min; duration 4-6 hours
67
what is the sodium channel blockers
ranolazine
68
what is ranolazine
inhibits the late phase of sodium current improving oxygen supply and demand improves diastolic function antianginal and anti-arrhythmic properties used when others hav failed
69
what are the risks with ranolazine
risk of drug interactions and can prolong QT interval
70
when are combination therapy used
used if there is intolerance or angina symptoms persist despite the optimal dosage of a single drug treatment tailored to how frequent angina episodes/attacks occur within a given week aimed at alleviating symptoms and supporting the heart
71
what is the benefit of combining nitrates with BB or CCB
decrease the degree of cardiac ischemia and improves exercise intolerance
72
what medications when used with BB have additive effects on SA and AV nodes
diltiazem or verapamil (CCB)
73
why is the combination of nitrate and sildenafil potentially dangeous
both cause vasodilation this can lead to lowering of BP and blood flow that can precipitate a heart attack
74
what considerations are made to determine medical therapy and surgical therapy for angina
patient dependent - testing results -pt age -symptom severity -stage/level of heart disease -peripheral artery disease
75
what is interventional therapy used for
primarily to improve symptoms when optimal medication therapy has failed beneficial when coronary arteries are significantly narrowed, there are many coronary arteries that are narrowed and when left main coronary artery is narrowed
76
has standing been shown to prolong life compared to medication therapy
no

Pharm2: Module 2 (4 decks)

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