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Flashcards in Antianginals Deck (30):
1

Which type of angina is caused by stresses?

Typical or exertional

2

What causes typical angina?

coronary arteries not able to transport enough oxygen to meet myocardium demand

3

If demand for oxygen is greater than available,
Then what?

necrosis = MI

4

2 other names for variant angina

atypical
Prinzmetals

5

Whats the difference on an EKG between typical and variant angina

with variant, elevated ST segment

6

Normal coronary arteries have mainly ___ receptors which with epi cause ____ which improves blood flow. Epi on ____ receptors cause increasing ____ demand on the heart. Individuals with variant angina have more ____ receptors than Beta 2 receptors which leads to _____ which results in lack of oxygenation due to _____.

B2
vasodilation
B1
oxygen
A1
vasoconstriction
vasospasm

7

List 6 factors that may trigger an angina attack

1. physical exertion
2. mechanical stress
3. increased contractillity
4. Increased HR/BP
5. Cold temps
6. hyperventilation

8

What is the MOA of nitrites/nitrates, beta blockers and Ca channel blockers as it relates to management of angina?

Relaxation of all SM = no contraction = arterial and venous vasodilation

9

Nitroglycerin works on endothelial cells that produce?

Nitric oxide

10

What are the 4 effects of nitrites/nitrates as it relates to angina?

1. vasodilation
2. decrease preload and venous return
3. decrease work
4. decrease oxygen demand

11

9 side effects of nitrites/nitrates as it relates to angina?

1. headache! due to rapid vasodilation
2. weakness/dizziness
3. flush
4. postural hypotension and syncope (increases with alcohol
5. tachycardia and increased peripheral resistance
6. rash
7. oxidation of hemoglobin to methemoglobin
8. decrease oxygen carrying capabilities (with large dose)

12

Which drug that treats angina is known to give a flushing side effect?

amyl nitrate

13

Name the 3 rapid onset angina drugs

1. amyl nitrate
2. nitroglycerin
3. transdermal patch

14

Name the 2 long acting angina drugs

1. Isordil
2. Imdur

15

Whats the epi limit for a angina patient?

1:100,000 epi - 2 cartridges = 0.04mg epi

16

5 groups of drugs used to treat unstable angina

1. nitrates
2. beta blockers
3. ca channel blockers
4. antiplatelet drugs
5. antithrombin therapy

17

Nitrates cause relaxation of all ____ ___. Uses a ___ messenger system. Results in ___ and ___ vasodilation.

Smooth muscle
second
arterial and venous

18

what are 4 routes of administration of nitrates?

1. sublingual
2. topical
3. oral
4. transdermal (12 hours on 12 hours off)

19

Which antiangina drug has the fastest onset?

amyl nitrate - Vaporole, white pack you mash and snort, onset is less than a minute, lasts 3-15 minutes

20

What the onset time for nitroglycerin placed sublingually?

1-3 minutes

21

Whats the max does of nitro in spray form?

3 times, 5 min apart

22

How long do the long acting nitrates last?

1. Isordil - onset 2-10 minutes, sublingual lasts 1-2 hours while oral pill lasts 4-6 hours
2. Imdur - onset 30-60 minutes and pill has half life of 4 hours

23

beta blockers are indicated for all acute coronary syndromes, whats their MOA?

Decrease workload of the heart by decreasing CO and arterial pressure, which decreases venous return, decreases preload and decreases oxygen demand

24

Beta blockers do NOT cause vasodilation and pts that have had an MI should always be taking them, decreases mortality. What is a side effect and who is it contraindicated for?

Bradycardia
Contraindicated in CHF, asthma, and variant angina

25

If your pt has angina but also has diabetes and asthma, what drug should you prescribe?

Selective beta blockers

26

beta blockers are often combined with diuretics to prevent what?

sodium retention

27

In presence of a beta blocker, epi no longer lowers ____ nor stimulates ____. Vasoconstrictive actions of epi are ___ bc mediated by _____

BP
HEART
unimpaired
alpha

28

Non selective beta blockers enhance the ____ response to epi: hypertension and reflex bradycardia

pressor

29

_____ may reduce effects of beta blockers when used for > 3 weeks

NSAIDS

30

Ca channel blockers have a ___ inotropic effect. They block ___ entry into the myocardial cell = less ____ inside of the cell which maintains troponins ____ effects by decreasing ____ of the heart. Bc the heart doesnt speed up, no ___ from angina. Some of these drugs cause SM relaxation of the coronary arteries = ______

Negative
Ca
Ca
inhibitory
contraction
pain
vasodilation