Angina

Question 1

treatment approach in Angina

Answer 1

1) decrease TPR –> decreases afterload
2) Decrease CO
3) Increase oxygen delivery –> CA vasodilation (decrease preload?)

Question 2

Drugs used in Angina Tx?

Answer 2

1) beta blockers (1st line )
2) CCBs
3) Nitrates (GTN)
4) Potassium channel activators

Question 3

Beta blocker used in the tx of Angina

Answer 3

Bisoprolol –> Unstable angina

Question 4

Clinical uses of Bisoprolol

Answer 4

Prophylaxis of stable Angina (First line) and Tx of Unstable Angina

Question 5

MoA of Bisoprolol

Answer 5

Reduces CO –> reduces O2 consumption

Question 6

Anti-arrythmic drugs used an alternative in the Tx of Angina when Beta blockers are contraindicated

Answer 6

Ivibradine

Question 7

CCBs used in the Tx of Angina

Answer 7

1) Verapamil (Acts of cardiac myocytes)
2) Diltiazem (Acts of heart and SM vasculature)
3) Nifedipine (Acts of SM vasculature)

Question 8

MoA of CCBs in Angina

Answer 8

1) Coronary vessel dilatation
2) decreases metabolic demands –> decreases TPR

Question 9

Contraindications of CCBs

Answer 9

1) HF–> lowers CO

Question 10

Clinical uses of CCBs in the Tx of Angina

Answer 10

1) In combo w/ beta blockers (Dihydropyridines) when monotherapy is insufficient
2) As an alternative tx in stable Angina

Question 11

Contraindication of Verapamil

Answer 11

In combo w beta blockers–> Heart block

Question 12

potassium channel activators used in the tx of angina

Answer 12

Nicorandil

Question 13

MoA of Nicorandil

Answer 13

• Both arterial and /venous dilator. (decreases TPR and perload)

Question 14

MoA of potassium channel activators

Answer 14

decrease preload and afterload

Question 15

Clinical uses of Nicorandil

Answer 15

comb w/ other anit-anginal tx Refractory angina resistant cases

Question 16

AE of Nicorandil

Answer 16

• Headache,
• flushing,
• dizziness,
• Hypotension

Question 17

durgs used in the Tx of Acute Angina
(stable)

Answer 17

GTN-Glyceryl Trinitrate
IV

• 1st line

*class: nitrate

Question 18

Drugs used in the tx of Chronic Angina (unstable)

Answer 18

Isosorbide mononitrate

class: nitrate

Question 19

MoA of Nitrates

*Isosorbide mononitrate/ GTN

Answer 19

°Better perfusion in myocardium
°Less metabolic demands
°Venorelaxation (Central Venopressure Reduction)
°Reduction of preload and afterload

Question 20

IV GTN is used in the Tx of?

Answer 20

1) Acute HF
2) stable (acute) Angina (lon-term tx)

Question 21

AE of Nitrates

*GTN/ Isosorbide mononitrate

Answer 21

Tolerance due to depletion of -SH groups but it wears off after a brief nitrate-free interval.

Uncommon:
°Postural hypotension,
°Headache,
°Reflex tachycardia.

Question 22

Contraindications of Nitrates

Answer 22

Hypotension

Question 23

class of Ranolazine

Answer 23

Anti-anginals,
Na+/Ca2+ exchanger
inhibitor

Question 24

MoA of Ranolazine

Answer 24

Ischemia causes increased Na+.

Ranolazine prevents Ca2+ exit via Na+/Ca2+
exchanger, thus inhibiting Na+ current. Indirectly it reduces Ca2+ and thus °(decreases End Diastolic Pressure), leading to an improvement in diastolic blood flow

Question 25

AE of Ranolazine

Answer 25

• Constipation (due to Ca+2 channel block in the GI tract)
• headache,
• dizziness,
• nausea,
• increased QT

Question 26

Contraindications of Ranolazine

Answer 26

1) long QT syndromes
2) patients that take drugs that prolong QT
(antipsychotics, class I & III anti-arrhythmic
drugs)