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Pharm I ( Melicia) > Angina > Flashcards

Angina Flashcards

1
Q

Define angina pectoris

A

an imbalance btwn the oxygen requirement of the heart and the oxygen supplied to it via the coronary aa.

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2
Q

Define stable angina (effort; classic)

A

inadequate blood flow in the presence of CAD

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3
Q

Define variant angina (vasospastic, Prinzmetal)

A

transient spasm of localized portions of the vessels resulting in sig. myocardial ischemia and pain

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4
Q

Define unstable angina (acute coronary syndrome)

A

present when episodes of angina occur at rest and when these is an increase in the severity, freq. and duration of CP in pts with previously stable angina

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5
Q

What determines the oxygen requirement of the heart?

A

diastolic factors: blood volume, venous tone

systolic factors: peripheral resistance, HR, heart force, ejection time

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6
Q

Describe the typical presentation of stable ischemic heart disease

A

brought on by exercise

relieved by rest/sublingual Nitro

substernal CP: squeezing, heaviness, tightness lasting usually 5-10min

Radiation: L/R arm, back, abd, neck

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7
Q

Which drugs are used in Angina Pectoris?

A

Nitrates

Beta Blockers

Calcium Channel Blockers

Misc. (Ranolazine, Ivabradine)

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8
Q

Nitrates MOA?

A

Nitroglycerin

releases nitric oxide in smooth muscle which activates guanylyl cyclase and increase cGMP —> vascular smooth muscle relaxation

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9
Q

Effects of Nitroglycerin

A

Smooth muscle relaxation

vasodilation decreases VR and heart size

may increase coronary floq

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10
Q

Clinical application for Nitroglycerin?

A

Oral/Transdermal: Prophylaxis

IV: ACS

Sublingual: acute episodes of angina

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11
Q

Nitroglycerin PK?

A

high first pass effect, so sublingual dose is much smaller than oral

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12
Q

Side effects of Nitroglycerin?

A

orthostatic hypotension, tachycardia, HA

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13
Q

Nitroglycerin drug interactions

A

Phosphodiesterase type 5 inhibitors- synergistic hypotension

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14
Q

Long acting Nitrate? Ultrashort acting Nitrate?

A

Transdermal

Amyl nitrite (not really used)

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15
Q

BB MOA

A

blocks sympathetic effects on heart and blood pressure, reduces renin release

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16
Q

Effects of BB?

A

decreased HR , CO and BP

decreases myocardial oxygen demand

17
Q

Clinical applications for BB in angina?

A

prophylaxis

18
Q

BB toxicities?

A

asthma, AV block, acute HF, sedation

19
Q

Name 3 CCBs. MOA?

A

Nondihydropyridine: Verapamil, Diltiazem

Dihydropyridine: Nifedipine

Nonselective block of L type calcium channels in vessels and heart

20
Q

Effects of CCBs

A

reduce vascular resistance, HR, and cardiac force results in decreased oxygen demand

21
Q

Clinical application for CCB?

A

prophylaxis of angina

HTN

22
Q

Side effects of CCBs?

A

Non-dihydropyridine: AV block, acute HF, constipation, edema

Dihydropyridines: excessive hypotension, baroreceptor reflex tachycardia

23
Q

What are good combo therapy options for pts with angina pectoris?

A

Nitrate/BB

Nitrate/CCB

depends on what is better tolerated

24
Q

What kind of drug is Ranolazine? MOA?

A

Sodium channel blocker

inhibits late sodium current in heart

25
Q

Effects of Ranolazine

A

reduces cardiac oxygen demand

fatty acid oxidation modification may improve efficacy of cardiac oxygen use

26
Q

Clinical application for Ranolazine?

A

Prophylaxis of stable angina

27
Q

Ranolazine toxicity?

A

QT interval prolongation

N, constipation, dizziness

28
Q

Ranolazine drug interactions?

A

Inhibitors of CYP3A increase Ranolazine concentration and duration of action

29
Q

Off label use of Ivabradine?

A

inhibits SA pacemaker–> reduction of HR reduces oxygen demand

30
Q

What should you use to treat acute episodes of angina?

A

Sublingual or sprayed Nitroglycerin

relief of discomfort within 2-4 mins can be expected

31
Q

What can you give to a pt with frequent anginal episodes?

A

BB such as Metoprolol

if intolerant= medium to long acting CCB i.e. Verapamil, Diltiazem or Amlodipine

Pharm I ( Melicia) (18 decks)

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