Pharm: Antianginal drugs Flashcards Preview

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Flashcards in Pharm: Antianginal drugs Deck (24):
1

What are the drug therapies for exertional angina?

Nitrates
CCBs
Beta blockers
Ranolazine
Ivabradine

2

Describe the mechanism of action of nitrates

Nitrates cause endothelium independent smooth muscle relaxation by activating GC to increase cGMP, dephosphorylates myosin light chains

Decreased venous return, decreased LV wall tension, reduced afterload and direct coronary artery vasodilation

3

Where in the body are nitrates most effective?

Systemic circulation

4

Clinical use of nitrates

Angina pectoris
Hypertensive emergencies
CHF

5

What are the most commonly used nitrates for angina?

Nitroglycerin
Isosorbide mono/dinitrate

6

Are nitrates used prophylactically?

Yes. They can be used as treatment or prophylaxis for exertional angina.

7

What are the side effects of nitrates?

Exaggeration of therapeutic effects:
-orthostatic hypotension
-reflex tachycardia
-headache
Tolerance can also develop

8

How do calcium channel blockers affect the action potential?

Slower AP upstroke, slowed conduction velocity
Inhibition of Ca influx during AP and also during diastole

9

What are the clinical uses of calcium channel blockers?

Angina Pectoris
Hypertension
Arrhythmias
Hypertrophic cardiopyopathy
Migraine
Raynaud's phenomenon

10

What are the calcium channel blockers used for angina?

Dihydropyridines: nifedipine, nicardipine, amlodipine
Verapamil
Diltiazem
Bepridil

11

Which CCB has the strongest negative inotropic and chronotropic effects?

Verapamil has the strongest inotropic and chronotropic effects

12

Which CCB has the strongest vasodilatory effect?

Nifedipine

13

What are the side effects of verapamil and diltiazem?

Bradycardia
CHF
Heart block
Hypotension

14

What are the side effects of nifedipine?

Reflex tachycardia: major adverse effect
Peripheral edema
Hypotension

15

What are the effects of cAMP in cardiac muscle?

Inotropy, lusitropy, chronotropy, dromotropy

16

What are the most used beta blockers for exertional angina?

Cardioselective: atenolol and metoprolol

17

Describe the elimination of beta blockers

Liver: Propranolol, carvedilol, metoprolol
Kidney: atenolol, nadolol, sotalol

18

What are the side effects of beta blockers?

Bronchospasm
Peripheral vasospasm
Exaggerated cardiac effects: bradycardia, heart block
CNS effects: insomnia, depression, fatigue

19

What are the contraindications for beta blockers?

Acute CHF
Bradycardia, heart block
Peripheral vascular disease
Insulin-dependent diabetes mellitus
Sexual impotence
Bronchospasm

20

What is ranolazine?

New class of antianginal drugs with a unknown mechanism
Inhibits pFOX, decreasing beta oxidation

21

What is ivabradine?

Funny current inhibitor
Newest anti-anginal drug

22

What are the side effects of ivabradine?

Luminous phenomena, bradycardia, AV block

23

Describe the effect of metoprolol on exercise performance

Decreases variation in heart rate and reduces ischemic changes in response to exercise

24

What are the nonpharmacological treatments of angina pectoris?

Exercise training
Angioplasty
Atherectomy
Stents
Intra-aortic balloon counterpulsation
CABG