Angina Pectoris Flashcards
What are modifiable for CAD(Coronary Artery Diseases
- HTN
- High Cholesterol
- DM
- Smoking
- Obesity
What are uncontrollable non modifiers in CAD
- Age
- Sex
- Race
- Heredity
Drugs used in treatment of Angina Pectoris
- Nitrates
- Beta blocker
- Ca2+ blockers
- Metabolic modifier
- Ivabradine
How does NO(Nitric Oxide) works
Work by activation of Nitric Oxide (NO)
eNOS(endothelial nitric oxide synthase) can be activated by:Acetylcholine, histamine, bradykinin, and serotonin.
NO+++
GTP ——–> c GMP———> Relaxation
Guanylyl cyclase
How Nitrates decreases cardiac oxygen demand?
Dilation of large veins lead to decrease preload and decrease
cardia work (decrease oxygen demand)
How Nitrates increase cardiac oxygen supply?
At high doses, nitrates cause arteriolar dilation (aorta)
leading to decrease of afterload (increase oxygen supply)
Other benefits of Nitrates:
Improve Collateral blood flow
Decrease coronary vasospasm
Inhibits platelets aggregation
Nitrates used clinically?
Nitroglycerin
1.Given sublingual, PO, transdermal, and IV forms
2. Isosorbide (Extended release)
Given PO
Side effects of Nitrates
Headache, flushing, and syncope
Reflex tachycardia and edema
Tachyphylaxis: Acute tolerance
Treatment of Methemoglobinemia
Methylene blue
Methemoglobinemia was reported with the use of _______
Amyl nitrate
________is converted to cyanide and may cause Cyanide poisoning
Sodium nitroprusside
What is the treatment of cyanide poisoning?
- Sodum thiosulfate, Amyl nitrite, Sodium nitrate
- Vit B12
Drug interactions: PDE5 inhibitors
Always ask the patient with chest pain at the ER if they took
sildenafil earlier.
It could be a deadly combination with Nitrate causing severe hypotension
What is Beta blocker MOA?
Act directly on the heart. No direct effect on blood vessels.
Decrease the force of contraction, HR and CO causing decrease
in oxygen demand
Most _______ blocker have been use in angina?
Beta blocker
Atenolol, metoprolol, bisoprolol, and propranolol
Cautions with Prinzmetal’s Angina
Beta blockers are contraindicated as they keep alpha 1 open
causing vasospasm.
Calcium Channel Blockers two types and name?
Dihydropyridine: Amlodipine and Nifedipine
Nonhydropyridine: Verapamil and diltiazem
Name the Cat+ channel blocker not used in US and MOA?
Bepridil is not used in the US
It dilates the coronary arteries
Blocks Na+ and K+ channels and may cause Torsades de Pointes
What is the name of a Metabolic modifier used in angina and the moa? contraindicated?
Ranolazine
It blocks late inward Na+ current
No effect on blood pressure or HR
Contraindicated with antiarrhythmic drugs class I and III due to prolongation of QT interval
What drug is Used in chest pain with CHF with LVEF<35%?
Ivabradine
Used in chest pain with CHF with LVEF<35%
Decreases heart rate by blocking the funny channel (IF current)
Used in patients who cannot tolerate BB blockers
What is the side effects of Ivabradine?
Bradycardia, AV block
Luminous phenomena (IF channel in the retina)
Which of the following drugs is pivotal in Rx of Anginal Pectoris?
A. HCTZ
B. Lisinopril
C. Propranolol
D. Nitroglycerin
