angina

Question 1

amyl nitrate

Answer 1

organic nitrate

inhalent - short acting

Question 2

nitroglycerin

Answer 2

organic nitrate

sublingual (short acting), there are also long acting preps

Question 3

isosorbide mononitrate

Answer 3

organic nitrate

oral - long acting

Question 4

isosorbide dinitrate

Answer 4

organic nitrate

sublingual - short acting, also oral/chewable long acting

Question 5

dihydropyridines

Answer 5

amlodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine

CCB - reflex tach

• Nifedipine and other dihydropyridines
  
  • Beneficial effects
    
    • Coronary vasodilation -> increased myocardial O2 delivery
    • Vasodilation of systemic arteries -> decreased afterload
  • Harmful effects
    
    • Increased risk of MI resulting from
      
      • Pronounced hypotension -> reflex tach -> increased cardiac work
      • Retrospective studies show that short acting CCBs should be avoided in patients with hypertension

Question 6

diltiazem

Answer 6

CCB - cardiac depressant

• Beneficial effexts
  
  • Reduced SA automaticity and AV conduction -> Decreased myocardial contractility and bradycardia -> reduced cardiac workload
• Harmful effects - potential for serious cardiac depression that could result in
  
  • Cardiac arrest
  • AV block
  • CHF

Question 7

verapamil

Answer 7

CCB - cardiac depressant

• Beneficial effexts
  
  • Reduced SA automaticity and AV conduction -> Decreased myocardial contractility and bradycardia -> reduced cardiac workload
• Harmful effects - potential for serious cardiac depression that could result in
  
  • Cardiac arrest
  • AV block
  • CHF

Question 8

non selective beta blockers

Answer 8

propranolol, nadolol, penbutolol, pindolol, timolol

Question 9

b1 blockers

Answer 9

acebutolol, atenolol, bisprolol, esmolol, metoprolol

Question 10

beta blockers with additional action

Answer 10

carteolol, carvedilol, labetolol, betazolol

Question 11

ranolazine

Answer 11

newer drug

Reduces intracellular Ca concentration = reduced contractility and work

Question 12

trimetazide

Answer 12

metabolic modulator

inhibit fatty acid ox in myocardium - shifts to utilize glucose instead

Question 13

allopurinol

Answer 13

• Inhibits xanthine oxidase (contributes to ox stress and endothelial dysfunction)
• High dose can prolong exercise time in patients with angina

Question 14

ivabradine

Answer 14

direct bradycardic agent

• • Inhibits the hyperpolarization activated sodium channel in SA node = slows heart

Question 15

fasudil

Answer 15

rho-kinase inhibitor

reduce coronary vasospasm in experemental animals

Question 16

Treatment protocol for angina

Answer 16

• Atherosclerotic disease
  
  • First line - modify risk factors (smoking, hyperteinos, hyperlipidemia, obesity) and add antiplatelet drugs (aspirin or clopidogrel) - may need to put on statin
  • Hypertensive patinst: monotherapy with slow release CCB or b-blocker may be enough
  • Normotensive: long acting nitrates may be suitable
  • Most effective drug combos
    
    • B blocker and CCBs or 2CCBs (nifedipine and verapamil) - these are good because they inhibit reflex tach
    • Reflex tach can be minimized by combining nitrates with CCB(verapamil - cardiac depressant) or b-blockers
• For angiopathic - nitrates and CCBs are more effective than b-blockers