KG - Pharm 2 Exam 2, Antianginal Drugs Flashcards
(51 cards)
etiology - “classic” angina
atheromatous obstruction of large coronary vessels, esp w/ exercise
treatment - “classic” angina
if uncontrolled by drugs may require coronary bypass or angioplasty
etiology - “varian” or “angiospastic” or “Printzmetal’s” angina
spasm or constriction in atherosclerotic coronary vessels
treatment - “varian” or “angiospastic” or “Printzmetal’s” angina
reversed by nitrates or CCBs
- you can’t stent a spasm so you must dilate w/ drugs
nitrates/nitrites MOA
- vasodilation via NO –> cGMP
- UNEVEN VASODILATION
- large veins dilated, increased venous capacity, decreased preload
- arterioles not dilated as much but still decreases afterload
DOC for ACUTE ANGINAL ATTACK?
nitrates/nitrites
nitrates/nitrites - the GOOD
- decreased cardiac workload: decreased preload & afterload
nitrates/nitrites - the BAD
- increased cardiac workload: decreased BP (so increased baroreflex) –> increased HR & contractility, decreased diastolic perfusion time
nitrates/nitrites provide ANGINAL RELIEF by ____
predominantly: decr myocardial O2 requirement
secondarily: redistribution of blood flow from normal to ischemic areas (even though total bflow unchanged)
nitrates also relax ___
smooth muscle in bronchi, GI, GU tracts
nitrates/nitrites pharmacokinetics
- oral nitrates - have HIGH FIRST PASS, rapid liver metabolization
- inhalation, sublingual, transdermal
why is sublingual nitrate/nitrite preferred?
- AVOID HEPATIC DESTRUCTION
- rapid absorption
- immediate relief, short duration
which nitrate/nitrite is fastest acting?
inhaled Amyl nitrite:
- volatile liquid
- inhaled
which nitrate/nitrite is IV?
nitroprusside, also fast acting
describe isosorbide dinitrate
- solid
- sublingual or oral tablet
nitrates/nitrites adverse effects
due to vasodilation:
- orthostatic hypotension
- tachycardia
- THROBBING HEADACHES
- frequent exposure to nitrates leads to TOLERANCE OR MARKED REDUCTION of most effects - CAN NOT USE LONG TERM
which CCB is indicated for HTN only?
slow release nifedipine - may provoke angina pectoris
which CCB increases HR?
nifedipine
which CCB decreases HR?
verapamil
what are CCBs good for in relation to angina?
for CHRONIC TREATMENT, not immediate relief
BENEFICIAL EFFECTS nifedipine/other -dipines
coronary vasodilation –> increased myocardial O2 supply & decr afterload
HARMFUL EFFECTS nifedipine/other -dipines
enhanced by development of MI
- rapid hypotension –> baroreflex –> incr cardiac workload
BENEFICIAL EFFECTS verapamil/diltiazem
(due to decr cardiac workload)
- decr myocardial contractility
- bradycardia caused by decr SA node automaticity/AV conduction
HARMFUL EFFECTS verapamil/diltiazem
potential for SERIOUS CARDIAC DEPRESSION that can end in arrest, AV block, CHF
