Chapter 54: Drugs for Angina Pectoris

Question 1

What is angina pectoris

Answer 1

• sudden pain beneath the sternum, often radiating to the left shoulder and arm
• oxygen supply to the heart is insufficent to meet oxygen demand

Question 2

what are the 2 goals of angina drug therapy

Answer 2

• prevention of myocardial infraction and death
• prevention of myocardial ischemia and anginal pain

Question 3

what are angina triggers

Answer 3

4 E
- eating a large meal
- exercise and other physical activity
- emotions
- extreme cold weather

Question 4

treatment strategy of chronic stable angina (exertional)

Answer 4

• increase cardiac oxygen supply
• decrease oxygen demand

Question 5

Chronic stable angina therapeutic agents

Answer 5

• Organic nitrates (Nitroglycerin)
• beta blockers (Metoprolol and propranolol
• calcium channel blockers (verapamil or nifedipine)
• Atrial- selective sodium channel blocker (ranolazine)

Question 6

Chronic stable angina (exertional) nondrug therapy treatment

Answer 6

• avoid factors (overexertion, heavy meals, stress, exposure to cold)
• decrease risk factors (smoking, hyperlipidema, hypertension, sedentary lifestyle)

Question 7

what is variant Angina (prinzmetal)

Answer 7

coronary artery spasm which restricts blood flow

Question 8

Variant Angina treatment strategy

Answer 8

• reduce severity and incidence of attacks
• increase cardiac oxygen supply

Question 9

variant angina therapeutic agents

Answer 9

• calcium channel blockers
• organic nitrates

Question 10

varient angina often occurs

Answer 10

during rest

Question 11

what is unstable angina

Answer 11

• severe CAD complicated by vasospasm, platelet aggregation, transient coronary emboli

Question 12

what are the symptoms of unstable angina

Answer 12

• angina at rest
• new onset exertional angina
• intensification of existing angina

Question 13

unstable angina treatment strategy

Answer 13

• maintain oxygen supply
• decrease oxygen demand

Question 14

therapeutic agents for unstable angina

Answer 14

• anti-ischemic therapy
• antiplatelet therapy
• anticoagulant therapy

Question 15

nitroglycerin dose

Answer 15

• three doses sublingually every 5 mins (tablet or spray), followed by IV therapy if perisitant ischemia or hypertension occurs

Question 16

beta blockers does

Answer 16

give first dose IV if chest pain is ongoing

Question 17

Acetylsalicylic acid should be used

Answer 17

indefinitely

Question 18

Acetylsalicylic acid examples

Answer 18

Aspirin
- Clopidogrel [Plavix]
- Ticlopidine [Ticlid]

Question 19

Anticoagulant therapy examples

Answer 19

• subcutaneous LMW heparin
• direct thrombin inhibitors
• factors Xa inhibitors
• IV unfractionated heparin

Question 20

Nitroglycerin [Nitrospray] MOA

Answer 20

acts directs on vascular smooth muscle to promtote vasodialtion (primarily in the veins)

Question 21

Nitroglycerin [Nitrospray] is used for

Answer 21

stable and variant angina

Question 22

Nitroglycerin [Nitrospray] pharmacokinetics

Answer 22

• t1/2: 5-7 mins
• large first pass effect

Question 23

Nitroglycerin [Nitrospray] adverse effects

Answer 23

• headache (severe but diminishes over time)
• orthostatic hypotension
• reflex tachycardia

Question 24

Nitroglycerin drug interactions

Answer 24

• hypotensive drugs
• Phosphodiesterase type 5 inhibitors (sildenafil [viagra])

Question 25

nitroglycerin negative effect

Answer 25

tolerance

Question 26

nitroglycerin translingual spray

Answer 26

- prime before use

Question 27

nitroglycerin transdermal delivery systems

Answer 27

every 12 hours

Question 28

nitroglycerin IV infusion

Answer 28

- slow infusion rate intially, continuous CV monitoring, diluted before administration, dont mix with other drugs

Question 29

nitroglycerin long acting preperations examples

Answer 29

- Isosorbide dinitrate [Isordil] - Isosorbide monitrate

Question 30

Nitroglycerin long acting preperations therapeutic uses

Answer 30

- long tern prophylaxis

Question 31

long acting preperations adverse effects

Answer 31

headache, hypotension, and reflex tachycardia

Question 32

beta blockers examples

Answer 32

- propranolol - metoprolol

Question 33

beta blockers adverse effects

Answer 33

- bradycardia - decreased atriventricular (AV) conduction - reduction of contractility - asthmatic effects - insomnia - depression

Question 34

beta blockers should be used in caution in patients with

Answer 34

diabetes

Question 35

calcium channel blockers examples

Answer 35

- verapamil - diltiazem - nifedipine

Question 36

calcium channel blockers are used for

Answer 36

stable and variant angina

Question 37

calcium channel blockers adverse effect

Answer 37

- dilation of peripheral arterioles leads to reflex tachycardia

Question 38

late sodium current inhibitor example

Answer 38

ranolazine [corzyna]

Question 39

Icosapent Ethyl [Vascepa] effects on ECG

Answer 39

causes QT prolongation

Question 40

Icosapent Ethyl [Vascepa] side effects

Answer 40

dizziness, headache, constipation, nasuea

Question 41

Icosapent Ethyl [Vascepa] contradictions

Answer 41

- concurrent use with strong CYP P450 3A4 drugs - severe renal or hepatic impairment

Question 42

Icosapent Ethyl [Vascepa] dose

Answer 42

BID, ** do not crush

Question 43

other drugs used for angina pectoris

Answer 43

- antiplatelets - antihyperlipidemics - ACEI

Question 44

initial therapy of variant angina

Answer 44

calcium channel blockers or long acting nitrate

Question 45

what is not effective with vasospastic angina

Answer 45

beta blockers