Antianginal agents

Question 1

What is a common symptom of CAD

Answer 1

Angina pectoris

Question 2

If a patient has chest pain that radiates to the neck, what symptoms will they have

Answer 2

choking

Question 3

If a patient has ulnar distribution, where is their angina most likely radiating to

Answer 3

left shoulder / arm

Question 4

What symptoms will a patient present with that has unstable angina or an acute MI

Answer 4

New onset
increase in intensity / frequency
increase in duration
occurs at rest

Question 5

What are the types of angina

Answer 5

effort angina
vasospastic angina
unstable angina

Question 6

What is the most common form of angina

Answer 6

effort / stable

Question 7

How will a patient with stable angina present

Answer 7

short lasting
heavy
burning
squeezing in chest
relieved at rest

Question 8

What is the cause of stable angina

Answer 8

inadequate blood flow in the presence of CAD

Question 9

How do you best treat effort angina

Answer 9

nitrates or rest

Question 10

What are other names for vasospastic angina

Answer 10

prinzmetal
variant

Question 11

What are the causes of vasospastic angina

Answer 11

coronary artery spasm causing decreased blood flow to the heart muscle

*uncommon pattern, episodic

Question 12

What is the treatment for vasospastic angina

Answer 12

coronary vasodilators
-nitrates
-Ca2+ blockers

Question 13

Why is ACS an emergency

Answer 13

from a rupture of atherosclerotic plaque and partial / complete thrombosis of coronary artery

Question 14

What happens if ACS isn’t treated

Answer 14

necrosis can occur leading to an MI

Question 15

Necrosis in the heart leads to an increase in which biomarkers

Answer 15

troponins
creatinine kinase

Question 16

How do you determine cardiac oxygen consumption

Answer 16

Wall stress/tension (Volume, pressure, thickness)
Heart rate
contractility

Question 17

What occurs in the heart when preload is changed

Answer 17

the ventricular stroke volume will chance

force of contraction will change

Question 18

What factors increase preload

Answer 18

Increased atrial contractility
Increase ventricular compliance
Decrease HR
Increased aortic pressure
Increased central venous pressure
-Decrease venous compliance
- Increase thoracic venous blood volume

Question 19

What is the most important factor affecting myocardial oxygen demand

Answer 19

Heart rate

Question 20

What is contractility influenced by in the heart

Answer 20

calcium

Question 21

What strategies can be used for angina relief

Answer 21

beta blocker
calcium channel blocker
organic nitrates
Na+ blockers
Interventional (IR / Cath lab / CABG)

Question 22

What are metoprolol and atenolol useful for

Answer 22

stable and unstable angina

Question 23

What is the MOA for beta-1 blockers

Answer 23

Decrease oxygen demand of the myocardium = decrease HR, CO,BP, Contractility

**will work at rest and during exertion

Question 24

Which patients should you avoid non-selective beta blockers in and why

Answer 24

patients with asthma because it will cause severe bronchospasm

Question 25

Which type of angina should beta blockers not be used in

Answer 25

vasospastic

Question 26

Why should Pindolol be avoided in patient with a prior MI / angina

Answer 26

because of its sympathomimetic affects

Question 27

What are the side effects of beta blockers

Answer 27

Cold hands / feet fatigue Weight gain

Question 28

What is recommended as the initial antianginal therapy (unless vasospastic)

Answer 28

Beta blockers

Question 29

Why should beta blockers not be stopped abruptly

Answer 29

needs to be tapered over 2-3 weeks to avoid rebound angina, MI, hypertension

Question 30

Which types of angina are calcium channel blockers useful for

Answer 30

stable and vasospastic angina

Question 31

What is the MOA of Ca2+ blockers

Answer 31

dilate arterioles causing a decrease in smooth muscle tone and vascular resistance

Question 32

What are contraindications of calcium channel blockers

Answer 32

AV block sick sinus syndrome symptomatic hypotension ACS grapefruit juice

Question 33

What are the side effects of Ca2+ blockers

Answer 33

lightheadedness hypotension bradycardia constipation swelling in feet / ankles

Question 34

When are non-dihydropyridines beneficial

Answer 34

in patients with atrial tachyarrhythmia

Question 35

When are non-dihydropyradines contraindicated

Answer 35

Risk for heart block heart failure

Question 36

how quickly does diltiazem work and where is it frequently used

Answer 36

immediately In the ER with afib+RVR

Question 37

Where in the body does verapamil have the greatest effect

Answer 37

myocardium

Question 38

When are organic nitrates indicated

Answer 38

stable, vasospastic, and unstable angina

Question 39

What is the MOA of nitrates

Answer 39

Venous dilation (decrease O2 requirement and preload) decrease in arteriolar resistance (decrease after load and O2 demand)

Question 40

What are the contraindications of nitrates

Answer 40

coadministration of PDE-5 inhibitors (viagra) severe anemia increased ICP circulatory failure / shock

Question 41

What are the side effects of nitrates

Answer 41

headaches dizziness hypotension flushing

Question 42

When is nitro utilized

Answer 42

anginal attacks

Question 43

Which sodium channel blocker is useful in angina

Answer 43

ranolazine

Question 44

How does Ranolazine help with angina

Answer 44

Inhibits late phase of Na+ currents which improves oxygen supply and demand

Question 45

What are the risks with ranolazine

Answer 45

Drug interactions prolonged QT

Question 46

When is isosorbide dinitrate useful

Answer 46

can be taken before exercise in anticipation of angina when mononitrate isn't wanted

Question 47

When is a combination therapy utilized with angina

Answer 47

when there is an intolerance or angina symptoms persist despite optimal dosage of single drug

Question 48

What determines the combination therapy someone is on

Answer 48

How frequently angina attacks occur within a given week Comorbidities and type of angina

Question 49

Which combination will help decrease cardiac ischemia and improve exercise tolerance

Answer 49

nitrate with beta blocker or calcium channel blocker

Question 50

What is sildenafil

Answer 50

PDE-5 inhibitor

Question 51

What is the MOA of Sildenafil

Answer 51

binds to guanylate cyclase receptors, increasing cGMP causing smooth muscle relaxation (vasodilation)

Question 52

What are the indications for sildenafil

Answer 52

erectile dysfunction PAH

Question 53

Why should Nitrate and sildenafil never be combined

Answer 53

it lead to hypotension and blood flow which can precipitate a heart attack