Angina Pectoris

Question 1

What are four key aspects of antidysrhythmic drug actions; aka why do they work?

Answer 1

1. State-dependent (of ion channels) 2. Selectively affect abnormal/depolarized cells. 3. Dependent on membrane voltage and spike frequency. 4. Selectively affect different parts of the heart (e.g. Class IV target A-V and S-A nodes)

Question 2

How is angina pectoris characterized (symptoms)?

Answer 2

Intermittent attacks of chest pains which radiates to the left arm/shoulder/jaw. Ass’d w/ excitation, exertion.

Question 3

What is the general developmental sequence of angina pectoris (5 steps)?

Answer 3

Coronary atherosclerosis-coronary narrowing-coronary insufficiency-myocardial hypoxia-angina pectoris

Question 4

What are the four types of angina and their O2 needs?

Answer 4

A: Typical: Inc O2 demand and fixed supply
B: Variant: Dec O2 supply, unchgd demand
C: Unstable: usually at rest, dec O2 supply, dec blood flow due to blood clot (acute emergency)
D: Microvascular: atherosclerosis in small coronary artery

Question 5

What are the four other names for the types of angina?

Answer 5

Typical=Stable/effort, Variant= Prinzmetal, Unstable is itself, Microvascular=Syndrome X

Question 6

Which angina has partially occlude lumen with just plaque? Muscles suddenly spasm? Platelets and thrombus on top of plaque?

Answer 6

1. Stable and microvascular
2. Variant angina
3. Unstable angina

Question 7

What are the two crucial ratios to remember for angina pectoris?

Answer 7

Coronary blood flow/cardiac work and

O2 supply/O2 requirement

Question 8

What are the three primary determinants of myocardial O2 supply (note which is major determinant)?

Answer 8

Coronary blood flow (major determinant), O2 content of blood and O2 extraction by myocardium

Question 9

What are the primary determinants of myocardial O2 consumption?

Answer 9

Ventricular systolic pressure, heart size, heart rate and myocardial contractility

Question 10

What is the afterload and what is the preload factor for the heart?

Answer 10

Ventricular systolic pressure and heart size, respectively

Question 11

What do clinicians hope to do to the myocardial O2 consumption with drugs?

Answer 11

Decrease it (and increase coronary blood flow)

Question 12

What are eight risk factors for angina?

Answer 12

Obesity, high blood cholesterol, physical inactivity, smoking, age, gender, family history, and hypertension

Question 13

What are the four classes of angina drugs?

Answer 13

Nitrates (“N”), beta blockers (“B”), and CCRB (“C”)

Question 14

What are the four possible mechanisms for altering supply/demand ratio and which drugs generally go with each?

Answer 14

Relaxation of resistance vessels (N/C), relaxation of capacitance vessels (N), blockade of sympathetic influence on heart (B) or coronary dilation (N)

Question 15

How do nitrates and nitrites work?

Answer 15

Interaction between thiols and NO to make nitrosothiols-activate guanylate cyclase-turns GTP to cGMP

Question 16

What does an increased cGMP cause (4 steps)?

Answer 16

1. Inc Ca2+ uptake by sarcoplasmic reticulum
2. Less ca2+ to interact with calmodulin
3. Decreased phosphorylation of MLC
4. Dec smooth muscle tone

Question 17

What causes NO tolerance?

Answer 17

Sulfhydral groups (SH) are oxidized and form disulfide groups, which are no longer reactive- this prevents the action of NO, so may need abstinence periods)

Question 18

How are nitrates degraded? CI Meds?

Answer 18

Phosphodiesterase-5 increases NO release which prevents breakdown of cGMP so effects last longer (viagra)

Question 19

How is nitroglycerin take for prompt relief of chest pain? What are other forms intended for?

Answer 19

Oral spray or sublingual (Nitrostat); anginal prophylaxis

Question 20

What are two drugs that specifically help with angina prophylaxis?

Answer 20

Isosorbide dinatrate and isosorbide mononitrate; nitroglycerin-like effect with a long duration of action

Question 21

What drug reports the reduction in frequency of anginal attacks?

Answer 21

Propranolol

Question 22

What two beta blockers are selective vs. non-selective? Has partial agonist activity (ISA)? 3. Membrane stabilizing action (LA)? 4. Lipid solubility?

Answer 22

1. Atenolol (beta-1) vs. propranolol
2. Pindolol (yes) vs. propranolol (no)
3. Metoprolol (yes) vs. atenolol (no)
4. Propranolol (high) vs. atenolol (low)

Question 23

What beta-blocker is most common for angina? 2nd most common?

Answer 23

Atenolol, metoprolol

Question 24

How do beta blockers affect elderly?

Answer 24

Both good and bad effects enhanced

Question 25

How does beta blockers affect the myocardial reserve?

Answer 25

Decrease (block cardiac beta-one)

Question 26

What three types of people must you be careful giving beta-blockers to?

Answer 26

Asthma (blocks bronchial beta-two), diabetes (blocks hepatic beta-two) and can exacerbate Raynaud’s

Question 27

What class of drugs may cause constipation, tachycardia, or hypotension?

Answer 27

CCBs

Question 28

What class of drugs may cause Nightmares, mental depression, insomnia?

Answer 28

Beta-blockers

Question 29

What are the two types of CCB’s and which are used more often with angina?

Answer 29

Dihydropyridines (DHPs): used more often

Non-DHP’s: Verapamil and diltiazem

Question 30

What is the Mech of action for CCBs?

Answer 30

Block Ca2+ through channels, causing dec in muscle tone.

Question 31

What type of angina does CCBs help the most?

Answer 31

Variant (or stable/effort)

Question 32

How are CCB’s given for angina?

Answer 32

Orally

Question 33

What drugs help stable/effort angina? 2. Variant? 3. Unstable?

Answer 33

1. BCN and aspirin

2. N/C and 3. BCM and anti-coagulants

Question 34

What are three aims in use of antianginal drugs and each of their goals/what used?

Answer 34

1. Tx of acute attack: oral spray or sublingual nitroglycerin
2. Short term prophylaxis: Nitroglycerin prior to anticipated physical/emotional stress
3. Long-term prophylaxis: Reduce frequency of anginal attacks (BCN)