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General Pharm > Angina Pharm > Flashcards

Angina Pharm Flashcards

1
Q

Typical Angina (Exertional)

A

Fixed atherosclerotic narrowing
Lasts no longer than 15 min
5-15 episodes/week
ST segment depression

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2
Q

Atypical Angina (At Rest)

A

Focal or diffuse coronary vasospasm which episodically reduces coronary flow
Transient ST segment elevation during angina

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3
Q

Unstable Angina

A

Rupture of plaque with platelet adhesion and decrease in coronary flow
Signals impending MI
Sx not relieved by 3 NTG tablets w/i 15 minutes should call 911

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4
Q

What can be used if Aspirin is contraindicated?

A

Clopidogrel

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5
Q

Tx Typical Angina

A

Decrease demand via B blockers
Anti-platelet via aspirin
Nitrate to decrease preload/afterload

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6
Q

Tx Unstable Angina

A 
MONA 
Morphine 
O2 
Nitroglycerine 
Aspirin
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7
Q

Organic Nitrates (NTG) MOA

A

Prodrugs that are sources of NO
Decrease both preload/afterload
Mainly relax large veins, decrease VR, decrease preload and O2 demand
Smaller decrease in after load
Directly dilate coronary aa. especially subendocardial regions compressed during systole

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8
Q

Molecular MOA of NTG

A

Activates guanylyl cyclase which increases cGMP which causes relaxation of the myosin light chain resulting in SM relaxation

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9
Q

What inactivates cGMP?

A

Phosphodiesterase

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10
Q

What is a longer acting nitrate than NTG?

A

Isorbide dinitrate, should be used for long term tx

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11
Q

What is the main adverse effect of Nitrates?

A

Headache, can be severe

Also facial flush, orthostatic hypotension

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12
Q

How do you avoid tolerance in NTG use?

A

Need a 8hr drug free time period per day

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13
Q

What are the two contraindications for NTG?

A

Erectile dysfunction drugs also work on cAMP and can cause dangerous fall in BP
Acute MI with right ventricular infarction bc higher right sided filling pressures are need (need to keep preload up to get same amt of blood flow)

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14
Q

CCBs with prominent cardiac effects

A

Verapamil

Diltiazem

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15
Q

CCBs with predominant arteriolar vasodilation effects

A

Dihydropyrididnes : Nifedipine, amlopdipine, felodipine

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16
Q

CCB MOA

A

Block Ca entry through L type channels –> relaxation of arteriolar SM
Decreased after load and O2 demand
Increased supply due to dilation of coronaries

17
Q

Verapamil/Diltiazem Effects on SA/AV Nodes

A

Decrease the rate of SA node depolarization and slow AV nodal conduction making them useful for tx supra ventricular tachyarrhythmias

18
Q

Are DHP’s or Verapamil/Diltiazem more potent arteriolar vasodilators?

A

DHP’s

19
Q

DHP hemodynamic effeects

A

decrease arterial pressure, reflex increase in HR, contractility and CO, peripheral blood flow improved

20
Q

Verapamil/Diltiazem hemodynamic effects

A

Reflex tachy due to arterial dilation blunted by direct negative inotropic effect (less Ca less contracting)
(Diltiazem less negative HR)

21
Q

Which CCBs are slowly absorbed and long acting?

A

Amlodipine, felodipine and isradipine (DHPs)

22
Q

What negative effect does Verapamil have?

A

Constipation

23
Q

What are Verpamil/Diltiazem use contraindicated with and why?

A

CI use with B blocker due to potential for AV block

24
Q

B Blockers should be used in every pt when?

A

After an MI

25
Q

Aspirin reduce mortality in?

A

Patents with both unstable and chronic stable angina

26
Q

Clopidogrel Mechanism

A

Inhibits ADP to its platelet receptor and activation of GP2b/3a complex
Irreversible, long term platelet inhibition

27
Q

Clopidogrel Clinical Indications

A

Unstable angina, prophylaxis and treatment of TIA and completed stroke
Pt undergoing stent replacement

28
Q

Abciximab Mechanism

A

Monoclonal Ab against Gp2b/3a receptor to inhibit platelet aggregation

29
Q

Abciximab Clinical Indication

A

Tx of unstable angina when angioplastly planned in 24hrs

30
Q

Acute prophylaxis and treatment of single angina use

A

NTG

31
Q

Maintenance therapy of chronic stable angina

A

B blockers, CCBs or long duration nitrates in combo

32
Q

Vasospastic angina

A

CCB or Nitrates

General Pharm (5 decks)

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