Angina drugs Flashcards
1
Q
First line treatment of angina
A
nitrates
CCBs
beta blockers
2
Q
nitrates- examples
A
nitroglycerin
3
Q
nitrate MOA
A
- dilation of veins
- dilation of large arteries
- dilation of coronary collateral
- prevent vasospasm (variant angina)
nitrate can be converted into nitric oxide
4
Q
nitrate- pharmacokinetics
A
- low oral bioavailability due to fast metabolism by the liver, use sublingual route instead
- rapid onset, short duration of action, excreted by kidneys
5
Q
nitrate- complications
A
tachyphylaxis- 8-12 hours of nitrate free period, usually at night
dependence- arterial and digital vasospasm if withdraw suddenly, have to be careful when without with chronic patients
6
Q
nitrate- drug cautions
A
- do not take with PDE5 inhibitors (slidenafil) because it causes hypotension then reflex tachycardia
- and soluble guanylate cyclase stimulators such as riociguat
7
Q
nitrate- contraindications and side effects
A
- orthostatic hypotension, tachycardia, headache
contraindicated in increased intracranial pressure patients
8
Q
nitrate- route of administration
A
- sublingual: immediate relieve
- oral: need high dose or sustained release formulation for prophylaxis
- subcutaneous: prophylaxis for nocturnal angina
- buccal or transmucosal: above the incisor under the upper lip, prophylaxis for a short time
- IV: coronary spasm
9
Q
CCBs
A
- artery and arterioles vasodilation
- reduce force of contraction of the heart
- reduce coronary spasm (variant angina)
- vascular selective one may cause hypotension (reduce coronary blood flow) and tachycardia (worsen)
10
Q
beta blockers
A
- reduce force and rate of contraction of the heart
- increasing the diastole duration, coronary blood flow duration and perfusion to the myocardium
- causes vasospasm (contraindicated in variant angina)
11
Q
nicorandil- MOA
A
- similar to nitrate: stimulate the guanylate cyclase activity
- activate the ATP-sensitive K channels in VSCM: hyperpolarization of smooth muscle and vasodilation
- reduce coronary spasm (variant angina)
- act on both artery and venous
12
Q
nicorandil- side effects
A
hypotension, tachycardia, headache
13
Q
trimetazidine- MOA
A
- inhibit the 3-KAT
- inhibit the fatty acid oxidation, have to switch to glucose oxidation for more efficient utilization of cardiac oxygen
- usable in low heart rate and bp patients
14
Q
trimetazidine- side effects
A
parkinson syndrome
15
Q
ranolazine- MOA
A
- inhibit the late Na current (usually seen in ischemia)
- reduce the Na influx and therefore reduce the influx of Ca by Na Ca exchanger
- reduce intracellular Ca overload and contractility
- reduce the cardiac workload
