Drugs for the Tx of Angina

Question 1

Inadequate supply of oxygen to the heart.

Answer 1

Myocardial Ischemia

Question 2

Where does pain radiate in angina pectoris?

Answer 2

Left shoulder and flexor surface of the arm.

Question 3

Correlation between the radius of the ventricular walls and oxygen demand.

Answer 3

Greater radius = greater oxygen demand

Question 4

Autoregulation

Answer 4

The intrinsic ability of an organ to maintain blood flow, even when perfusion pressure is low.

Question 5

When do we NOT see autoregulation?

Answer 5

During Dilation and Constriction

Question 6

Three Types of Angina

Answer 6

1) Exertional
2) Vasospastic
3) Unstable

Question 7

Exertional Angina

Answer 7

Chest pain occurs when you exert yourself (exercise or emotional upset) and is the result of arteriosclerotic plaques reducing blood flow through the heart.

Question 8

Causes exertional angina.

Answer 8

Coronary artery disease (atherosclerotic plaques in the coronary arteries).

Question 9

Vasospastic angina.

Answer 9

Pain develops at rest due spasms in the epicardial coronary arteries.

Question 10

Unstable angina.

Answer 10

Precedes a myocardial infarction.

Occurs at rest or with minimal exertion.

Question 11

Vascular Capacitance definition.

Answer 11

The ability of a blood vessel to increase the volume of blood it holds without increasing the blood pressure.

Question 12

Types of angina treated by organic nitrates.

Answer 12

Exertional, vasospastic, and unstable.

Question 13

How do organic nitrates work?

Answer 13

Relaxes vascular smooth muscle by release NO, a potent vasodilator.

Question 14

Vasodilatory potency of Nitroglycerin.

Answer 14

Veins > Arteries > Arterioles.

Question 15

How does Nitroglycerin affect myocardial oxygen demand?

Answer 15

It reduces myocardial oxygen demand because it vilates the veins, causing:

1) Decreased venous return to the heart (decreased preload)
2) Ventricular wall tension and oxygen demand are reduced.

Question 16

Nitroglycerin sometimes causes a reflex _______.

Answer 16

Tachycardia because it causes the arteries to vasodilate, and this causes a drop in BP, so the body tries to compensate by increasing the BP.

Question 17

Which heart muscle is most vulnerable to ischemia in exertional angina?

Answer 17

Endocardium.

Question 18

Redistribution pattern of blood flow in exertional angina?

Answer 18

From Epi to endocardium

Question 19

Adverse effects of organic nitrates.

Answer 19

1) Postural Hypotension

2) Reflex tachycardia

Question 20

Solubility of organic nitrates (IMPORTANT)

Answer 20

LIPID SOLUBLE.

Question 21

3 Routes of Administration for organic nitrates:

Answer 21

1) Sublingual
2) Topical
3) Oral

Question 22

When to use sublingual nitrates?

Answer 22

Exertional or Vasospastic angina, or as prophylaxis if you’re doing an activity that can cause an anginal attack.

Question 23

Cool thing about sublingual nitrates and metabolism.

Answer 23

They bypass the liver and go directly to the bloodstream.

Question 24

Onset of action for sublingual nitrates.

Answer 24

1-5 minutes.
Gets in the bloodstream in 1 minute.
Has maximal effect in 5 minutes.
Effects last for 20 minutes.

Question 25

Absorption time for topical nitrates.

Answer 25

3-18 hours

Question 26

Metabolism of oral nitrates.

Answer 26

They get metabolized in the liver, so may need higher doses to get an effect.

Question 27

Tolerance is most likely to occur with which form of organic nitrates?

Answer 27

Oral

Question 28

If it ends in “olol,” it’s a __________.

Answer 28

Beta blocker

Question 29

If it ends in “pril,” it’s a _________.

Answer 29

ACE inhibitor

Question 30

Beta blockers are used to treat what kinds of angina?

Answer 30

Exertional and Unstable.

Question 31

Do NOT use beta blockers to treat this kind of angina.

Answer 31

Vasospastic

Question 32

Effects of propanolol on myocardial oxygen demand.

Answer 32

1) Decreases CO and heart rate.
2) Decreases afterload.
3) Increases preload/end diastolic volume - thus increasing oxygen demand.
4) OVERALL net effect is that it decreases oxygen demand.

Question 33

Propanolol effects on coronary vessels.

Answer 33

Reduced CO and HR lead to decreased blood to the heart through the coronary vessels, so they constrict as a result.

Increased coronary vascular resistance.

Question 34

Why are Propanolol (Beta blocker) and Nitroglycerin combined to treat angina?

Answer 34

Because they block out each other’s adverse effects:

1) Propanolol can increase end diastolic volume, which is counteracted by Nitroglycerin, which reduces cardiac preload by causing vasodilation.
2) Nitroglycerin can cause reflex tachycardia, which is counteracted by the beta blocker (reduces sympathetic CO and HR).

Question 35

3 drugs that are calcium channel blockers.

Answer 35

Nifedipine
Verapamil
Diltiazem

Question 36

Calcium channel blockers are used for what type of angina?

Answer 36

ALL types!

Question 37

MOA of Calcium Channel blockers.

Answer 37

Reduce Ca2+ influx through SA and AV nodes, ventricular muscle, and vascular smooth muscle.

Question 38

Effects of Ca2+ channel blockers on myocardial oxygen demand.

Answer 38

1) Cause vascular smooth muscle to relax, causing vasoDILATION, which decreases afterload.
2) Has no effect on preload.
3) Can reduce contractility and heart rate.
4) Vasodilation causes a reflex Tachycardia.
5) Dilates coronary arteries and arterioles to increase blood to the heart.

Question 39

Adverse effects of Calcium channel blockers.

Answer 39

1) Hypotension and edema from excessive vasodilation.
2) Bradycardia and Congestive Heart Failure.
3) Gingival Hyperplasia

Question 40

Dealing with an acute anginal attack in the dental office.

Answer 40

1) Stop dental tx.
2) Put pt in upright 45 degree angle position.
3) Give sublingual Nitroglycerin tablet.
4) Give oxygen 6 L/min
5) Give another dose of Nitroglycerin if symptoms don’t go away after five minutes.
6) Repeat and call for medical help.