2 - Cardiovascular III

Question 1

There are three families of anti-anginal drugs:

Answer 1

Nitrates

Beta Blockers

CCBs

Question 2

When we treat angina we’re really just:

Answer 2

reducing myocardial oxygen demand

Question 3

Vasospastic (prinzmetal) angina is treated by:

Answer 3

Increasing myocardial oxygen supply: CCBs and nitrates, which both relax coronary artery spasm

BETA BLOCKERS ARE NOT USED

Question 4

Nitroglycerin relieves traditional angina by:

Answer 4

VENOdilation (reduced preload)

The nitrate is converted to NITRIC OXIDE!

Question 5

Nitroglycerin relieves atypical angina by:

Answer 5

relaxing and preventing spasm in the coronary arteries

Question 6

What are the main AEs of nitroglycerin?

Answer 6

Headaches

Orthostatic HypoTN

Reflex Tachycardia

Question 7

Why would it be appealing to give a beta blocker with nitro?

Answer 7

To reduce reflex tachycardia

Question 8

Which drug has actions identical to nitroglycerin?

Answer 8

Isosorbide

Question 9

Which CCBs are used to treat Angina?

Answer 9

Verapamil

Diltiazem

Nifedipine

Question 10

Which drug can be given alongside CCBs/Beta Blockers/Nitrates to prevent angina?

Answer 10

Ranolazine

Question 11

What is the MOA of Ranolazine?

Answer 11

Reduces the accumulation of sodium and calcium in the myocardial cells, making the cells more efficient and preventing excessive excitation

Maybe.

Question 12

In patients with stable angina, which drugs are used to prevent MI and death?

Answer 12

1. Antiplatelets
2. Cholesterol-lowering drugs
3. ACE inhibitors

Question 13

In patients with stable angina, which drugs are given to reduce anginal pain?

Answer 13

Beta Blockers

CCBs

Long acting nitrates

Question 14

A patient presents with angina. He has a history of heart failure and has a second degree block. Which medications should be given?

Answer 14

Nitrates and a CCB. NOT A BETA BLOCKER

Question 15

A 64 year old male with COPD presents with angina. Which drugs should he receive?

Answer 15

CCBs and nitro. No beta blockers!

Question 16

Antiplatelet drugs are most effective at preventing _______

Anticoagulants are most effective at preventing ________

Answer 16

Antiplatelet = Prevention of arterial thrombosis

Anticoagulant = Prevention of venous thrombosis

Question 17

What are anticoagulants?

Answer 17

Drugs that reduce production of fibrin

Question 18

What is the MOA of heparin and all its derivatives?

Answer 18

Enhance the activity of antithrombin → inactivation of Thrombin and Factor Xa

Question 19

Is heparin polar or nonpolar?

Answer 19

It is HIGHLY polar

Cannot cross membranes

Question 20

Heparin has two actions:

Answer 20

1. It increases inactivation of Xa by binding to Antithrombin and increases its activity against factor Xa
2. It inactivates thrombin by bind to BOTH antithrombin and thrombin, forming a complex that is inert

THESE ARE SEPARATE PROCESSES

Question 21

An overdose of heparin can be treated with:

Answer 21

Protamine sulfate

Question 22

Which antianginal drugs are used for standard and variant angina?

Answer 22