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Pharmacology II Exam II CSV Drugs > Angina > Flashcards

Angina Flashcards

1
Q

What is Angina Pectoris?

A

Recurrent chest pain or discomfort when part/some of the heart does not get enough oxygen

Imbalance between oxygen requirement of the heart and oxygen supplied via the coronary vessels is the primary cause

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2
Q

What is angina a symptom of?

A

Coronary Artery Disease (CAD)

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3
Q

Where is the typical location of anginal pain?

A

Retrosternal or slightly to the left of midline, occasionally limited to extra thoracic sites

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4
Q

Where can anginal pain radiate to?

A

Neck, throat (chocking sensation)
Jaw, teeth (toothache)
Left shoulder, arm (ulnar distribution)
Epigastrium (heartburn)

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5
Q

What is the typical mode of onset, offset, and duration of angina?

A

Gradually comes (with increasing intensity) then slowly fades away (usually 2-15 minutes)

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6
Q

If a patient presents with new onset angina, that is increased in frequency, intensity, or duration or occurs at rest what should be your differential?

A

Unstable angina or evolving acute MI

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7
Q

What might a patient describe angina as?

A

Tightness, pressure, squeezing, heaviness or burning in the chest.

Heavy weight or band across my chest

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8
Q

What factors can aggravate angina?

A

Physical exertion
Emotional stress
After eating heavy meals
lying down

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9
Q

What factors can relieve angina?

A

Rest
Activity cessation
Withdrawal of stressor
Pharmacotherapy

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10
Q

What are the types of angina?

A

Effort angina
Vasospastic angina
Unstable angina

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11
Q

What is the most common type of angina?

A

Effort angina

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12
Q

What is the cause of effort angina?

A

Inadequate blood flow in presence of CAD - reduction of perfusion due to fixed obstruction of coronary artery and increased myocardial oxygen demand induces ischemia

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13
Q

What is the treatment of effort angina?

A

Nitrates, or rest

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14
Q

What is the cause of vasospastic angina?

A

Coronary artery spasm causing decreased blood blow to the heart muscle

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15
Q

What are the precipitators of vasospastic angina?

A

Occurs at rest, unrelated to physical activity, heart rate, or blood pressure

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16
Q

What is the treatment for vasospastic angina?

A

Coronary vasodilators (nitrates and calcium channel blockers)

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17
Q

What is the treatment of unstable angina?

A

HOSPITAL ADMISSION, aggressive therapy to prevent progression to MI

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18
Q

What is preload?

A

Initial stretching of cardiac muscle cells prior to contraction - change affects ventricular stroke volume

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19
Q

What is afterload?

A

Force or load against which the heart contracts to eject the blood

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20
Q

What is the most important factor affecting myocardial oxygen demand?

A

Heart Rate

21
Q

Increased heart rate increases the hearts

A

oxygen consumption

22
Q

Contractility is influenced by a variety of forces including the concentration of this electrolyte?

A

Calcium

23
Q

Positive chronotropes are going have what effect on heart rate?

A

Increase HR

24
Q

Negative chronotropes are going to have what effect on heart rate?

A

Decrease HR

25
Q

Positive inotropes strengthen the force of what

A

heart rate

26
Q

Negative inotropes weaken the force of

A

heart rate

27
Q

Inotropic drugs alters the strength of the

A

contraction of the heart

28
Q

What beta-blockers are anti-anginal?

A

Metoprolol and Atenolol

29
Q

Metoprolol and Atenolol are effective in what type of angina?

A

Unstable angina (work at rest and during exertion)

30
Q

What beta blocker should be avoided in patients with prior MI or angina due to sympathomimetic effects?

A

Pindolol

31
Q

What are the side effects of B-adrenergic side effects?

A

Cold hands and feet
Fatigue
Nausea, weakness, and dizziness
Dry mouth, skin, and eyes
Weight gain

32
Q

B-adrenergic blockers are recommended as initial antianginal therapy in patients except in

A

Vasospastic angina or other contridindications

33
Q

B-blockers should not be discontinued abruptly but tapered over 2-3 weeks to avoid

A

rebound angina, MI, and hypertension

34
Q

This beta blocker causes less bronchial constriction than

A

propranolol

35
Q

Atenolol is less effective than metoprolol in preventing

A

complications of hypertension

36
Q

What is the MOA of calcium channel blockers?

A

Inhibit entrance of the calcium into cardiac and smooth muscle cells of the coronary and systemic arterial beds

37
Q

What are the contraindications of calcium channel blockers?

A

Pre-existing conduction disorders (AV block, sick sinus syndrome)

Symptomatic hypertension
Acute coronary syndrome
Grapefruit Juice

38
Q

What are the side effects of Calcium Channel Blockers?

A

Lightheadedness
Low BP
Slow HR
Constipation
Swelling in feet and ankles

39
Q

What are the dihydropyridine calcium channel blockers?

A

Amlodipine
Nifedipine
Felodipine

40
Q

What are the non-dihydropyridine calcium channel blockers?

A

Verapamil
Diltiazem

41
Q

What calcium channel blockers can worsen heart failure?

A

Non-dihydropyridines (Verapamil and Diltiazem)

(all calcium channel blockers are contraindicated in heart failure)

42
Q

Verapamil has a greater negative inotropic effect than

A

Amlodipine

43
Q

What agents are effective in effort, vasospastic and unstable angina treatment?

A

Isosorbide mononitrate
Nitroglycerine
Isosorbide dinitrate

44
Q

What are the contraindications of organic nitrates?

A

Coadmin of PDE-5 inhibitors (Sildenafil)
Severe anemia
Increased intracranial pressure
Circulatory failure and shock

45
Q

What are the side effects of organic nitrates?

A

Headaches (most common)
Dizziness
Lightheadedness
Nausea
Flushing
Low BP

46
Q

What is the MOA of Ranolazine, a sodium channel blocker?

A

Inhibits the late phase of sodium current improving oxygen supply and demand

47
Q

When is Ranolazine used?

A

When all other treatments have failed

48
Q

What are the side effects of Ranolazine?

A

Drug interactions and QT prolongation

Pharmacology II Exam II CSV Drugs (4 decks)

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