Angina

Question 1

PQRST approach to CP

Answer 1

P-Precipitating factors
P-Pallative measures
Q- Quality of pain 
R- Radiation 
S- Severity 
T- Timing

Question 2

Nitroglycerin MOA

Answer 2

-Release NO in smooth muscle–>activates guanylyl cyclase–>Increase cGMP

Question 3

Nitroglycerin effects

Answer 3

Smooth muscle relaxation=Vasodilation–> especially of veins=reduce venous return=reduce preload and CO

Question 4

Nitroglycerin Side effects

Answer 4

1. Compensatory Tachycardia
2. Headache
3. Orthostatic Hypotension

Question 5

Nitroglycerin Clinical Application

Answer 5

1. Prophylaxis (transdermal)
2. ACS (IV)
3. Angina (sublingual)

Question 6

Nitroglycerin drug interactions

Answer 6

Synergistic hypotension with PDE-5 inhibitor (Sildenafil)

Question 7

Nitroglycerin PK

Answer 7

High first-pass effect:

-Sublingual dose much smaller

Question 8

Transdermal NTG

Answer 8

• Prophylaxis of angina

- Loss of response is common after 10-12 hrs exposure to drug

Question 9

Beta-Blockers reduces what 3 things?

Answer 9

1. Conduction velocity, automaticity (dromotropic)
2. Contractility (inotropic)
3. HR (chronotropic)

Question 10

Propanolol

Answer 10

Non-selective Beta1 and Beta antagonist

Question 11

Metoprolol

Answer 11

• Selective B1 receptor antagonist

- Can become non-selective @ high doses

Question 12

Beta blocker MOA/Effects

Answer 12

Block sympathetic effects on heart:
Decreased HR, contractility, CO
2. Decreased blood pressure
3. Decreased Myocardial oxygen demand

Question 13

Beta blocker clinical application

Answer 13

Prophylaxis of angina

Question 14

Which beta blocker causes the blood brain barrier and causes tremor/anger?

Answer 14

Propanolol

Question 15

Calcium channel blockers MOA

Answer 15

Inhibit influx of calcium by blocking L-type calcium channel of cardiac and vascular smooth muscle

Question 16

Verapamil and Diltiazem effects

Answer 16

1. Reduced HR by slowing AV node
2. Reduced cardiac force
3. Reduced vascular resistance

Question 17

Ranolazine MOA

Answer 17

Inhibits late sodium current in heart

Question 18

Ranolazine effects

Answer 18

Reduces cardiac oxygen demand

Question 19

Ranolazine clinical applications

Answer 19

Prophylaxis of stable angina

Question 20

Ranolazine toxicity

Answer 20

QT prolongation

Question 21

Ranolazine drug interactions

Answer 21

inhibitors of CYP3A increase ranolazine concentration and duration of action