Angina drugs Flashcards

1
Q

Is angina a symptom or a dz?

A

Symptoms

- heaviness, squeezing, pressure and tightness

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2
Q

What is the cause of angina pectoris?

A

Imbalance between supply and demand

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3
Q

What are some causes of Prinzmental angina?

A
  • Underlying atheromas

- Nocturnal episodes because of venous return increase which triggers neurogenic a-adrenergic coronary vasospasm

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4
Q

What is silent or ambulatory ischemia?

A

Ischemia without pain

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5
Q

What is the cause demand or supply for classic angina?

A

Demand

  1. decrease cardiac work
  2. Shift myocardial metabolism
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6
Q

What is the cause demand or supply for variant angina?

A

Supply

  1. Reverse spasm
  2. treat the atherosclerosis
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7
Q

What is the cause demand or supply for unstable angina?

A

Supply and demand
S1. Reverse spasm
S2. treat the atherosclerosis

D1. decrease cardiac work
D2. Shift myocardial metabolism

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8
Q

What are the some determinants of myocardial 02 demand?

A

Ventricular wall stress
HR
Contractility
Basal metabolism

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9
Q

What is LaPlaces relationship and what is it used for?

A

T=(P*r)/2h
Where r is radius and h is thickness

  • Calculates Tension which is a tangible force action o the myocardial fibers
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10
Q

What are some things that increase pressure and radius?

A

P- AS and HTN
R- Increase ventricular filling

Both lead to increase O2 consumption

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11
Q

What is the relationship between wall thickness and O2 consumption?

A

Inverse

- Hypertrophied heart muscle has lower wall stress and O2 consumption per gram

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12
Q

What doe arteriolar tone and venous tone synomonous with in terms of stress?

A

Systolic and diastolic wall stress respectively

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13
Q

What are some things that affect supply?

A
  1. Total coronary blood flow (aortic diastolic pressure and duration of diastole)
  2. LV EDP (ejection fraction)
  3. pAO2 (Hematocrit and saturation, anemia)
  4. Membrane diffusion (thickness)
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14
Q

What are some things that affect demand?

A

HR

Intraventriular wall stress (preload, after, contractility and wall thickness)

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15
Q

What are the classic anginal drugs?

A

Nitrates
B-blockers
Ca-blockers

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16
Q

What are the physiologic effects of nitrates?

A

Venodilation

  • decrease preload
  • decrease pulmonary vascular r
  • decrease LV EDP

Minimal change in total coronary blood flow

main effects are decrease preload and LV EDP

17
Q

What are the phosphodiesterase type 5 inhibitors?

A

Viagra
Cialis
Levitra

18
Q

What are the physiologic affects of Ca channel blockers?

A
  1. Increase total coronary blood flow by decreasing aortic diastolic pressure
  2. Decrease in contractility
19
Q

What are the clinical uses of Ca channel blockers?

A

Prophylaxis of angina
HTN
Others

20
Q

What is a classical management for classical angina?

A

B- blockers

21
Q

What is the physiological affects of beta blockers?

A

Decrease HR and contractility

Decrease Aortic diastolic pressure.

Slightly raise CA pressure and LV EDP.

22
Q

Which are more b1 selective, Atenolol, metoprolol or propranolool?

A

Aten and Metoprolol

23
Q

What are the MOA of the new drugs for angina?

A
  1. Target Na+/Ca2+ Exchanger
  2. Shift myocardial metabolism
  3. Inhibit “funny current” Na+ channels
  4. Inhibit Rho Kinase
24
Q

What is Ranolazine?

A

Reduces late Na channel that facilitates Ca entry via NCX

Reduction in intracellular Ca reduces contractility

25
Q

Trimetazidine MOa?

A

pFOX inhibitor which reduces fatty acids oxidation and shifts metabolism towards glucose oxidation. Which lowers oxygen demand

Not approved

26
Q

What is the MOA of Ivabradine?

A

Selective If Na channel blocker

- slows cardiac rate

27
Q

What is the MOA of Fasudil?

A

Inhibitor of SM Rho kinase

Reduces coronary vasospasm