Angina Drugs

Question 1

type of angina associated with atheromatous plaques that partially occlude 1 or more coronary arteries
constitute 90% of angina cases

Answer 1

atherosclerotic angina

angina of effort or classic angina

Question 2

responsible for less than 10% of angina cases
involves reversible spasm of coronaries, usually at site of an atherosclerotic plaque
may deteriorate into unstable angina

Answer 2

vasospastic angina
rest angina
variant angina
Prinzmetal’s angina

Question 3

increased frequency and severity of attacks that result from combination of atherosclerotic plaques, platelet aggregation, and vasospasm
immediate precursor of MI

Answer 3

unstable angina
crescendo angina
acute coronary syndrome

Question 4

therapeutic strategies in angina

Answer 4

1. increasing oxygen delivery

2. reducing oxygen requirement

Question 5

ultra-short acting nitrate
releases NO, increases cGMP, relaxes smooth muscle (esp vascular)
used for cyanide poisoning
inhalational
side effect: METHEMOGLOBINEMIA

Answer 5

Amyl Nitrite

Question 6

which portion of ETC is affected by cyanide?

Answer 6

Complex IV (cytochrome oxidase)

Question 7

antidote for cyanide poisoning?

Answer 7

amyl nitrite inhaled + IV sodium nitrite + IV sodium thiosulfate

Question 8

disease entity due to occupational exposure to nitrates

alternating development of tolerance (during work week) and loss of tolerance (over the weekend) every Monday

Answer 8

Monday disease

Question 9

short-acting nitrate
more for the vein - preload
used for angina, ACS
side effects: headache, TOLERANCE (transdermal)
dangerous hypotension with PDE inhibitors

Answer 9

nitroglycerin

isosorbide dinitrate, isisorbide mononitrate

Question 10

what occurs in nitrate-induced headache?

Monday disease

Answer 10

meningeal blood vessel vasodilation

Question 11

CCB
dihydropyridine blocker
block voltage-gated L-type Ca channels (vascular > cardiac)

Answer 11

nifedipine

amlodipine, felodipine. nicardipine, nisoldipine, clevidipine, israpidine

Question 12

non-dihydropyridine CCB

block voltage-gated L-type Ca channel (cardiac > vascular)

Answer 12

verapamil

Question 13

non-dihydropyridine CCB
block voltage-gated L-type Ca channel (cardiac > vascular)
used for: RAYNAUD’S PHENOMENON, DOC FOR PRINZMETAL’S ANGINA
side effects: heart failure, AV block, sinus node depression

Answer 13

diltiazem

Question 14

drugs that cause gingival hyperplasia?

Answer 14

Nifedipine
Cyclosporine
Phenytoin
Verapamil

Question 15

non-selective beta blockers
used for angina prophylaxis
side effects: EXCESSIVE BETA BLOCKADE (bronchospasm, AV block, heart failure, CNS sedation), masks hypoglycemia in DM patients, erectile dysfunction

Answer 15

propranolol

pindolol, timolol, labetalol, carvedilol, nadolol, levobunolol, metipranolol

Question 16

metabolism modifier
cytoprotective agent
inhibits beta oxidation of fatty acid by inhibiting 3-ketoacyl-CoA thiolase which enhances glucose oxidation
prevent decrease in ATP in ischemic/hypoxic states
side effect: EPS, gait instability, restless leg syndrome
interacts with MAOIs

Answer 16

trimetazidine

Question 17

metabolism modifier
reduces a late, prolonged Na current in myocardial cells –> decreased intracellular Na –> increased Ca expulsion via Na-Ca exchanger –> decreased intracellular Ca –> decreased cardiac force and work
may also modify fatty acid oxidation
used for prophylaxis of angina
side effects: QT prolongation, nausea, constipation, dizziness

Answer 17

ranolazine

Question 18

metabolism modifier
in funny Na current in SA node, decreases hyperpolarization-induces inward pacemaker current –> decreased HR and cardiac work
used for prophylaxis of angina, heart failure
side effects: bradycardia, hypertension, atrial fibrillation

Answer 18

ivabradine