Drugs for Angina Pectoris

Question 1

angina pectoris

Answer 1

chest pain
beneath the sternum and radiating; when O2 supply to heart inefficient; its a symptom; secondary to atherosclerosis of coronary artery

Question 2

how to address angina pectoris

Answer 2

increase blood flow to the heart and decrease the demand (how angina meds work)

Question 3

3 types of angina

Answer 3

chronic stable/exertional; variant; unstable

Question 4

chronic stable/ exertional

Answer 4

with predictable stress or exertion; physical activity; CAD; reduced flow angina no flow MI

Question 5

variant

Answer 5

occurs during rest, caused by coronary artery vasospasm

Question 6

unstable (pre infarction)

Answer 6

progressive severity unrelated to activity; indicates impending MI; require immediate emergency intervention

Question 7

non-drug angina therapy

Answer 7

no overexertion, heavy metals, emotional stress, exposures to cold; quit smoking, reduce BP, reduce hyperlipidemia; an active lifestyle

Question 8

two main goals of angina drugs

Answer 8

prevention of MI and death, and prevention of myocardial ischemia and angina pain

Question 9

antianginal drugs

Answer 9

organic nitrates (for all)
beta-blockers (stable and unstable)
CCb (for all)

only symptomatic relief

Question 10

stable angina treatment steps

Answer 10

nitrates
nitrates and beta-blockers
nitrates BB CCB
coronary artery bypass graft

Question 11

Anti-Anginal Tx: Nitrates

Answer 11

vasodilation on smooth muscle(venous); given IV transdermal subling buccal and oral(no likely to hepatic 1st pass)

nitroglycerin
isosorbide dinitrate
Isosorbide mononitrate

Question 12

nitrates for stable angina

Answer 12

decrease oxygen demand and decrease venous return and decrease ventricular filling and preload

Question 13

nitrates for variant angina

Answer 13

relaxes or prevents spasm in coronary arteries and increase o2 supply

Question 14

nitroglycerin

Answer 14

admin as soon as pain starts;

termination of anginal attack; ; 3 doses in 10 minutes; short term prior to exertion; close TIGHT

Question 15

nitroglycerin side effects

Answer 15

headache, hypotension, reflex tachy; do not mix with PDE 5 sildenafil (dilation); lowest dose; sub ling 1-2; no alcohol

protect from heat light moisture

Question 16

Anti-Angina Tx: Beta Blockers

Answer 16

for stable decrease deman and increase o2; 1st for angina effort; not for variant;

Propranolol
Metoprolol

Question 17

Propranolol

Metoprolol

Answer 17

beta-blocker

goal hr resting 50-60 and exertional 100; aids in preventing reflex tachy in patient taking nitrates

Question 18

Anti-Anginal Tx: CCBs

Answer 18

stable: decrease o2 demand which decreases demand and contractility;

variant: relax increase o2
Verapamil
Nifedipine
Diltiazem

Question 19

Nifedipine

Answer 19

CCB

reflex tachy side effect