PHARM-- antianginals

Question 1

patients with NSTEMI are not candidates for __

Answer 1

fibrinolytics

Question 2

4 general effects of fibrinolytic therapy

Answer 2

• sx resolution
• get hemodynamic stability
• reduce biomarker
• resolve ST elevation

Question 3

block NE release to decrease cardiac work and myocardial oxygen consumption

Answer 3

BB

Question 4

decreases HR, contractility, SBP; cardioprotective; antiarrhythmic properties

Answer 4

beta blocker

Question 5

which beta blocker targets Alpha, B1, B2

Answer 5

carvedilol

Question 6

which BB Targets B1 but at higher dose can target B2

Answer 6

metroprolol

Question 7

these are indications for what class?

• For 3 yrs in all w/ normal LV function after ACS
• all who have LV dysfunction (EF < 40%) w/ HF or prior MI
• Chronic therapy in all other ppl w/ SIHD or other vasc. dz

Answer 7

beta blocker

Question 8

which class has C/I of

• High degree heart block
• Sick sinus syndrome
• Severe asthma/COPD (caution)
• Vasospastic angina

Answer 8

BB

Question 9

which class has the ADR of

• Hypotension, brady
• 1st deg. Heart block
• Bronchospasms
• Glucose intolerance (non-vasodilating BB)
• Impotence
• Feeling cold

Answer 9

Beta blocker

Question 10

you should titrate your BB to HR of ____ at rest, ____ during exercise

Answer 10

• at rest: 55-60 bpm
• w/ exercise: < 100 bpm

Question 11

which BB is preferred in pts w/ DM

Answer 11

Carvedilol

Question 12

which type of CCB is preferred in Afib, a flutter

Answer 12

non DHP

Question 13

which type of CCB is preferred if on BB already

Answer 13

DHP

Question 14

which type of CCB is preferred in HFrEF

Answer 14

DHP

Question 15

which type of CCB is a potent arterial vasodilator w/ variable to no inotropic effects

Answer 15

DHP- CCB

Question 16

which type of CCB is a moderate vasodilator w/ significant SA and AV conduction inhibition, negative chronotropic and ** inotropic** effects

Answer 16

non-DHP

Question 17

block transmembrane Ca currents in vascular smooth muscle to cause arterial vasodilation

Answer 17

CCB

Question 18

effect of ____

* Direct vasodilation of epicardial arterials to ↑ O2 supply
* ↓ myocardial O2 demand by reducing systemic vascular resistance & systolic pressure
* No effect on exercise; no tolerance issues

Answer 18

CCB

Question 19

which type of CCB does this extra thing:

↓ myocardial O2 demand *by decreasing HR and contractility *

Answer 19

non-DHP

Question 20

Drug of choice for reducing sx w/ vasospastic angina

Answer 20

CCB

Question 21

these are ADR seen in which type of CCBs

increased angina, gingival hyperplasia

Answer 21

DHP

Question 22

these are ADR seen in which type of CCBs

bradycardia, AV block, sinus node dysfunction

Answer 22

Non-DHP

Question 23

these are common ADR of what class

Hypotension, worsening HF, peripheral edema, constipation, HA, flushing, dizzy

Answer 23

CCBs

Question 24

increased cGMP levels cause less intracellular Ca release to produce vascular smooth muscle relaxation

Answer 24

nitrates

Question 25

increased cGMP levels cause less intracellular Ca release to produce vascular smooth muscle relaxation

Answer 25

nitrates

Question 26

First line for **Immediate relief** of angina

Answer 26

short acting nitrates

Question 27

* ↑ myocardial supply by **direct vasodilation of large epicardial arterials & reduces vasospasms** * ↓ myocardial demand by **venous dilation (decrease preload) and arterial dilation (decreases afterload & BP)** * Improve exercise tolerance and time to onset of angina

Answer 27

nitrates

Question 28

C/I inclues using erectile dysfunction meds (sildenafil, vardenafil, tadalafil)

Answer 28

nitrates

Question 29

# ADR of * **Hypotension, HA** * **Flushing** * **Reflex tachy.** *** tolerance** * Methemoglobinemia * Syncope, Dizziness, palpitations

Answer 29

nitrates

Question 30

how do you manage nitrate tolerance

Answer 30

nitrate free interval each day (12 for patch, 8-12 for tabs)

Question 31

which med should not be stopped abruptly, d/t rebound tachy

Answer 31

nitrates

Question 32

blocks late Na+ channel to stop late sodium entry into myocardial cell which decreases Ca entry (Na-Ca exchanger) to decrease wall tension (myocardial oxygen demand)

Answer 32

ranolazine

Question 33

has no effect on HR and BP; prolongs exercise duration and time to angina

Answer 33

ranolazine

Question 34

used in combo w/ BB, CCB, LA nitrates for refractory angina & NOT to be used in acute anginal episodes | NOT a sole indicator

Answer 34

ranolazine

Question 35

# has these C/I * Severe renal impairment (CrCl < 30ml/min) * Liver cirrhosis * Use of clarithromycin, antiretroviral meds, azole antifungals

Answer 35

ranolazine

Question 36

use caution when giving this medication in Existing QT prolongation or with meds that also do it (Class Ia or III antiarrhythmics except amiodarone)

Answer 36

ranolazine

Question 37

# has these ADR * Dose dependent QT prolongation * Dizziness * HA * Nausea * Constipation * asthenia

Answer 37

ranolazine

Question 38

thrombolytic made from **recombinant DNA**

Answer 38

altepase (rTPA)

Question 39

dissolves stable fibrin rich clots by **activating plasminogen to plasmin**

Answer 39

rTPA, RPA, TNK

Question 40

The most fibrin specific of the three; used in STEMI but not pulmonary embolisms

Answer 40

tenecteplase (TNK)

Question 41

which two fibrinolytics is from the mutant of human wild-type

Answer 41

RPA & TNK

Question 42

3 scenerios of using fibrinolytics in STEMI

Answer 42

* STEMI w/in 12hrs of ischemia/sx onset * w/in 12-24 hrs + sx of ongoing ischemia * Time to hospital for PCI >120 mins

Question 43

rank the antianginals in order of 1st line through 4th line

Answer 43

1. Beta blockers 2. CCB 3. Nitrates 4. ranolazine

Question 44

Avoid IV NTG in patients w/ ____

Answer 44

right ventricular infarcts