Antianginal Drugs

Question 1

What is angina?

Answer 1

crushing, strangling chest pain caused by accumulation of metabolic waste products in muscle. Reduced blood flow and oxygen delivery

Question 2

What drugs increase coronary blood flow?

Answer 2

nitrates and calcium channel blockers

Question 3

What drugs decrease HR?

Answer 3

Beta blockers and some calcium channel blockers

Question 4

Which drugs decrease preload?

Answer 4

nitrates

Question 5

Which drugs reduce afterload?

Answer 5

calcium channel blockers

Question 6

Which type of angina is not exercise induced?

Answer 6

Variant Angina

Question 7

What types of angina occur at rest?

Answer 7

Variant and unstable angina

Question 8

Which types of angina have a ST segment depression?

Answer 8

Stable and some unstable

Question 9

Which types of angina have a raised ST segment

Answer 9

variant angina

Question 10

What causes stable vs. unstable vs. variant angina?

Answer 10

Stable is caused by atherosclerotic lesion
Unstable is a mixture of a lesion and vasospasm
Variant is spasm of coronary artery

Question 11

What do the nitrates do and what is their mechanism of action?

Answer 11

act on endothelial cells to release NO, causing vasodilation and reducing venous return to the heart, decreasing preload, and vasodilation of arteries, reducing afterload

Question 12

What are the nitrate drugs?

Answer 12

Nitroglycerin, isosorbide dinitrate and mononitrate, amyl nitrite

Question 13

What is a side effect of amyl nitrite

Answer 13

Amyl nitrite can cause methemoglobinemia, used for patients with cyanide poisoning

Question 14

What conditions are nitrates used for?

Answer 14

Any form of angina - stable, unstable, variant

Question 15

What are side effects of nitrates?

Answer 15

orthostatic hypotension, reflex tachycardia, throbbing headache, methemoglobinemia. Sublingual drugs can cause burning sensation; oral results in few SE.

Question 16

What is nitrate tolerance?

Answer 16

Tolerance occurs due to depletion of intracellular sulfhydryls and densensitization of soluble guanylyl cyclase.
It’s recommended to avoid nitrates at night when oxygen needs are the lowest.

Question 17

Which Beta blockers are used for Angina?

Answer 17

Atenolol and Metapropolol - selective B1 blockers

Nadolol and Propanolol - non-selective beta blockers

Question 18

How do Beta Blockers treat Angina?

Answer 18

Prophylactic Tx of stable angina, can be combined with nitrates to reduce HR
Reduce HR, CO, and conduction velocity
Decrease renin release
Decrease sympathetic outflow to periphery

Question 19

What are side effects of Beta Blockers

Answer 19

can precipitate heart failure, hypotension, increased airway resistance (non-selective), depression, insomnia, NVD, ED.

Question 20

Contraindications for Beta Blockers

Answer 20

Patients with asthma
diabetics, B blockers masks hypoglycemic shock
Patients with CHF
If patients don’t respond to Beta blockers, may have variant angina

Question 21

What are the Calcium channel blockers that cause bradycardia?

Answer 21

Verapamil, Diltiazem, Bepridil

Question 22

Which calcium channel blockers cause tachycardia

Answer 22

Dihydropyridines

Question 23

What types of angina can calcium channel blockers be used for?

Answer 23

All 3: stable, unstable, variant. Reduces vasospasm, afterload and preload

Question 24

What are side effects of Verapamil, Diltiazem, and Bepridil

Answer 24

Bradycardia, Hypotension, CHF, Skin rash, Constipation. Can be combined with nitrates

Question 25

What are the side effects of Dihydropyridines (the DIPINES)

Answer 25

Tachycardia, hypotension, dizziness, skin rash, peripheral edema. CANNOT be combined with nitrates due to tachycardia x2

Question 26

How does aspirin treat angina?

Answer 26

antiplatlet function, prevents blood clotting with turbulent flow. Lose dose should be used on a daily basis

Question 27

How does dipyridamole treat angina?

Answer 27

Blocks adenosine reuptake in coronary arteries, acting as a vasodilator. Used in Unstable angina only!

Question 28

What does Ranolazine do?

Answer 28

Inhibits FA oxidation since it uses a lot of O2. Use carbohydrates for energy instead which require less oxygen. Overall, reduce O2 consumption in heart.

Question 29

How does Ivabradine treat angina?

Answer 29

Blocks sodium channel in SA node, use for both arrhythmias and angina

Question 30

What is combination therapy treatment for angina?

Answer 30

Aggrenox: aspirin/extended release dipyridamile