Flashcards in Pharm: Antianginal drugs Deck (24):
What are the drug therapies for exertional angina?
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
Where in the body are nitrates most effective?
Clinical use of nitrates
What are the most commonly used nitrates for angina?
Are nitrates used prophylactically?
Yes. They can be used as treatment or prophylaxis for exertional angina.
What are the side effects of nitrates?
Exaggeration of therapeutic effects:
Tolerance can also develop
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
What are the clinical uses of calcium channel blockers?
What are the calcium channel blockers used for angina?
Dihydropyridines: nifedipine, nicardipine, amlodipine
Which CCB has the strongest negative inotropic and chronotropic effects?
Verapamil has the strongest inotropic and chronotropic effects
Which CCB has the strongest vasodilatory effect?
What are the side effects of verapamil and diltiazem?
What are the side effects of nifedipine?
Reflex tachycardia: major adverse effect
What are the effects of cAMP in cardiac muscle?
Inotropy, lusitropy, chronotropy, dromotropy
What are the most used beta blockers for exertional angina?
Cardioselective: atenolol and metoprolol
Describe the elimination of beta blockers
Liver: Propranolol, carvedilol, metoprolol
Kidney: atenolol, nadolol, sotalol
What are the side effects of beta blockers?
Exaggerated cardiac effects: bradycardia, heart block
CNS effects: insomnia, depression, fatigue
What are the contraindications for beta blockers?
Bradycardia, heart block
Peripheral vascular disease
Insulin-dependent diabetes mellitus
What is ranolazine?
New class of antianginal drugs with a unknown mechanism
Inhibits pFOX, decreasing beta oxidation
What is ivabradine?
Funny current inhibitor
Newest anti-anginal drug
What are the side effects of ivabradine?
Luminous phenomena, bradycardia, AV block
Describe the effect of metoprolol on exercise performance
Decreases variation in heart rate and reduces ischemic changes in response to exercise