Vasodilators in Angina

Question 1

HR and contractility are decreased with ___ and ____.

Answer 1

Beta-blockers and some Ca++ channel blockers

Question 2

Flow to ischemic subendocardial tissue is improved with _____, _____, and _____.

Answer 2

nitrates, Beta-blockers, and Ca++ channel blockers

Question 3

Coronary blood flow is increased with _____ and _____.

Answer 3

nitrates; Ca++ channel blockers

Question 4

Preload is decreased by _____.

Answer 4

nitrates

Question 5

Afterload is decreased by _____.

Answer 5

Ca++ channel blockers

Question 6

What does CCB stand for?

Answer 6

Ca++ channel blockers

Question 7

How do you treat Variant/Prinzmetal Angina?

Answer 7

vasodilators: nitrates and Ca++ channel blockers

Question 8

Unstable angina is ACUTELY treated with?

Answer 8

clot: aspirin, heparin, GPIIB-IIIA inhibitors, PTCA/CABG,
fibrinolytics

arrhythmia: Beta-blockers
pain: NTG, morphine

Question 9

What is the post-MI treatment?

Answer 9

ACEIs, statins, blockers, aspirin, clopidrogel (if post-stent).

Question 10

How do nitrates work?

Answer 10

converted to nitric oxide (NO) at or near the plasma membrane of vascular smooth muscle cells –> increasing cGMP–> relaxation of smooth muscle

Question 11

What is the best route for nitrate admin?

Answer 11

sublingual

Question 12

What is the t1/2 of a nitrate?

Answer 12

2-8 min

Question 13

What are some important SEs for nitrates?

Answer 13

low BP, headache, tolerance

Question 14

Name 3 Ca++ channel blockers.

Answer 14

1. Verapamil (Calan)
2. Diltiazem (Cardizem)
3. Nifedipine (Procardia)

Question 15

What are these drugs?

1. Verapamil (Calan)
2. Diltiazem (Cardizem)
3. Nifedipine (Procardia)

Answer 15

Ca++ channel blockers

Question 16

How do Ca++ channel blockers work?

Answer 16

Block of L-type Ca++ channels in cardiac and smooth muscle –> smooth muscle relaxation

Question 17

Which Ca++ channel blocker should NOT be used?

Answer 17

Nifedipine (Procardia)

Question 18

When are Ca++ channel blockers used?

Answer 18

1. angina
2. arrhythmias
3. HTN

Question 19

What are the important SEs of Ca++ channel blockers?

Answer 19

1. cardiac depression

2. flushing, edema, dizziness, nausea, constipation

Question 20

What is Ranolazine (Ranexa)?

Answer 20

an inhibitor of the late Na+ current

Question 21

When is Ranolazine (Ranexa) used?

Answer 21

as an add on for angina or as a sub. for beta-blockers

Question 22

Use this as an add on for angina or as a sub. for beta-blockers.

Answer 22

Ranolazine (Ranexa)

Question 23

What are some important SEs for Ranolazine (Ranexa)?

Answer 23

1. QT prolongation

2. other CV effects (less common)

Question 24

When is a beta-blocker used for angina?

Answer 24

in stable angina with a concurrent arrhythmia or HTN

Question 25

Which beta-blocker is used in angina?

Answer 25

Metoprolol (Lopressor), atenolol

Question 26

Use this drug in a pt with stable angina with a concurrent arrhythmia or HTN.

Answer 26

Metoprolol (Lopressor) or atenolol-- both beta blockers

Question 27

What is Metoprolol (Lopressor)?

Answer 27

a beta blocker

Question 28

When is Metoprolol (Lopressor) contraindicated?

Answer 28

in asthmatics or with peripheral vascular disorders

Question 29

Name 2 nitrates.

Answer 29

1. nitroglycerin (NTG) | 2. oral nitrates