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Pharmacology > 4.6 Antianginal Drugs > Flashcards

4.6 Antianginal Drugs Flashcards

1
Q

What is angina pectoris a symptom of?

A

coronary heart disease

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2
Q

Angina pectoris presents as a sudden, sevre, pressing chest pain resulting from…

A

myocardial ischemia

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3
Q

With Angina Pectoris the imbalance in oxygen demand may be due to what 3 things?

A
  • Exercise
  • A spasm of a vascular muscle
  • Obstruction of blood vessels (atherosclerosis)
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4
Q

What type of angina is characterized by chest pain precipitated by some activity, minimal or non-existent symptoms at rest?

A

Stable Angina

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5
Q

What type of angina is characterized by, chest pain that occurs at rest, and with an increase in the severity, frequency, and duration in patients with previously stable angina?

A

Unstable angina (acute coronary syndrome)

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6
Q

What type of angina is characterized by chest pain caused by a spasm of a coronary artery?

A

Variant angina (vasospastic angina)

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7
Q

What are the organic nitrates used to treat angina? (3)

A
  • Nitroglycerin
  • Amyl nitrite
  • Isosorbide dinitrate
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8
Q

What are the calcium channel blockers used to treat angina? (3)

A
  • Dihydropyridines
  • Verapamil
  • Diltiazem
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9
Q

What are the beta-blocking drugs used to treat angina?

A
  • Propranolol
  • Atenolol
  • Metoprolol
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10
Q

What are the newer drugs used to treat angina? (2)

A
  • Ranolazine
  • Trimetazidine
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11
Q

What organic nitrate is used as a 1st line for acute angina pectoris attacks?

A

Nitroglycerine

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12
Q

What can nitroglycerine be comined with to increase its efficacy?

A

beta-blockers

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13
Q

What organic nitrate is useful in treating cyanide poisoning?

A

Amyl nitrite

  • Nitrite converts hemoglobin to methemoglobin which has a high affinity for cyanide
  • Sodium nitrite is an antidote for cyanide
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14
Q

How is amyl nitrite administered?

A

inhalation

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15
Q

Which organic nitrate is long-acting, and why?

A

Isosorbide dinitrate

  • Through its metabolite mononitrate
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16
Q

How is isosorbide dintrate administered?

A

orally

17
Q

What vascular smooth muscle is more sensitive to organic nitrates?

A

Veins

  • Arteries require a higher concentration
  • Epicardial coronary artery also responsive
18
Q

What are the effects of nitrates on platelets? (2)

A
  • Decrease in platelet aggregation
  • Useful in treating unstable angina
19
Q

What are the toxicity effects of nitrates? (2)

A
  • Throbbing headache
  • Orthostatic hypotension
    • b/c they are vasodilators, which reduce BP
20
Q

Where do CCBs bind?

A

Alpha 1 L-type calcium channel

  • Verapamil + diltiazem bind to 1 region
  • Dihydropyridines (nifedipine) binds to another region
21
Q

Which CCB is a more selective vasodilator and may cause reflexed increase in HR?

A

Dihydropyridines (nifedipine)

22
Q

Which CCBs is cardiac muscle sensitive to?

A

Verapamil + Diltiazam

23
Q

What is the effect of CCBs on cardiac muscle?

A
  • Dec in contractility, dose-dependently
  • Dec in CO
24
Q

What CCB is vascular smooth muscle more sensitive to?

A

nifedipine

25
Q

What vascular smooth muscle is more sensitive to CCBs (nifedipine)?

A

Arteries

26
Q

What effect do CCBs have on vascular smooth muscle?

A

Dec in peripheral resistance

27
Q

What CCBs are cerebral blood vessels sensitive to?

A

Verampamil + nicardipine (another dihydropyridine)

28
Q

What toxicity is verapamil more so the cause of?

A

Serious cardiac depression

  • Bradycardia, av block, cardiac arrest, heart failure
29
Q

What toxicity is nifedipine more so the cause of?

A

Reflex tachycardia

  • Increasing the risk of MI in pts with HTN
30
Q

What is the effect of combining verapamil with beta-blockers?

A

more cardiac depression = bad

31
Q

What is the effect of combining nifedipine with beta-blockers?

A

Complementary to beta-blockers

  • nifedipine causes reflex tachycardia and beta-blockers prevent reflex tachycardia
32
Q

What are beta-blocking drugs extremely useful in the management of?

A

Stable angina

  • By dec HR, BP + contractility which reduces the myocardial oxygen demand
33
Q

In what type of angina is the use of beta-blockers questionable?

A

Variant Angina

  • b/c it is caused by spasms
34
Q

What is the toxic effect of giving an initial high dose of beta-blockers?

A

Heart failure

35
Q

What is the toxic effect of sudden withdrawl of beta-blockers?

A

Rebound overstimulation of the heart

  • Once you block these receptors the heart responds by expressing more receptors
  • When BB are withdrawn catecholamines are binding to all of these extra receptors = overstimulation of the heart
36
Q

What class of antianginal drugs have the toxic effect of worsening asthma?

A

Beta-blockers

37
Q

What is the mechanism of action of Ranolazine?

A

Sodium channel-blocker

  • Interfering with the Na-Ca exchanger
  • Depression of intracellular [Ca]
  • Reducing heart contractility and work
38
Q

What is the mechanism of action of Trimetazidine?

A

Metabolic modulator, shifting myocardial metabolic pathway by ​inhibiting fatty acid oxidation

39
Q

What drug can trimetazidine be combined with to tx angina?

A

nifedipine

Pharmacology (18 decks)

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