1 - Antianginals

Question 1

What happens when the oxygen demand of the myocardium exceeds the amount of available oxygen?

Answer 1

Necrosis occurs = myocardial infarction

ANGINA first

Question 2

Describe Variant (Atypical, Prinzmetal’s) Angina?

Answer 2

• Rare - 4/100,000 people
• Have more alpha 1 receptors than beta 2 receptors in their coronary arteries (vasoconstriction)
  
  • Epinephrine - usually increases rate and output, but now vasoconstricts coronary arteries (alpha 1)

Question 3

What is the EKG diagnosis of Variant angina?

Answer 3

Elevated S-T segment which is not present in normal angina

Question 4

What are the treatments of unstable angina?

Answer 4

• Nitrates
• Beta blockers
• Calcium channel blockers
• Antiplatelet drugs
• Antithrombin therapy

Question 5

How do nitrites/nitrates work?

Answer 5

• Cause relaxation of all smooth muscle
• Results in arterial and venous vasodilation
• Decreases venous return to heart (decrease preload)
• Decrease work, O2 demand

Question 6

What are the common side effects of nitrites and nitrates?

Answer 6

• Vasodilation = intense/fast = headaches
• Flush
• Postural hypotension and syncope
• Tachycardia and increased peripheral resistance
• Methemoglobin
  
  • Decreases ovygen carrying capabilities

Question 7

What do nitrates oxidize hemoglobin into?

Answer 7

Methemoglobin

Question 8

What are the common preparations of nitrates?

Answer 8

• Amyl nitrate - source of nitric oxide (vasodilator) - fastest onset
• Nitroglycerin - rescue drug, photosensitive, patch - up to 12 hrs
• Isosorbide dinitrate (Isordil) - long acting, 2-10 min onset
• Isosorbide mononitrate (Imdur) - 30-60 min onset

Question 9

How do beta blockers work?

Answer 9

• Decrease workload of the heart
• Decreasing cardiac output (afterload) and arterial pressure
• Decreases venous return
• Decreases preload
• Decreases oxygen demand
• Decreased myocardial oxygen demand

Question 10

Beta blockers do not cause ________?

Answer 10

Vasodilation

Question 11

Patients with a history of MI will always be taking what?

Answer 11

Beta Blockers

Question 12

What is contraindicated for taking beta blockers?

Answer 12

• Variant Angina

Question 13

What are some characteristics of cardioselective vs nonselective beta blockers?

Answer 13

• Non-Selective Beta blockers
  
  • Contraindicated in asthmatics
• Cardioselective Beta blockers
  
  • Preferred for insulin-dependent diabetics and asthmatics

Question 14

What drug has a negative inotropic effect?

Answer 14

Calcium channel blockers

Question 15

What do calcium channel blockers cause?

Answer 15

• Vasodilation of coronary arteries (amlodipine)
• Decrease force of contraction of myocardium (verapamil, diltiazem)
• Vasodilate peripheral arteries and veins, leads to reduced work load on heart (nifedipine, nicardipine)

Question 16

In a patient taking antianginals, can you use epinephrine?

Answer 16

Yes, but limit (1:100,00) in local anesthesia to 2 cartridges