Anginals Flashcards
Atenolol, metoprolol, nadolol, and propranolol have been approved for angina pain. What type of drugs are these?
Beta blockers
Following an MI, there is a high level of circulating catecholamines that will produce harmful consequences if their actions go unopposed. They cause the heart rate to increase, which leads to a further imbalance in the supply-and-demand ratio, and irritate the conduction system of the heart, which can result in potentially fatal dysrhythmias. What is the DOC for this condition?
Beta Blockers
There are three chemical classes of CCBs: phenylalkylamines, benzothiazepines, and dihydropyridines
commonly represented by verapamil, diltiazem, and amlodipine, respectively.
Angina pectoris (chest pain) occurs because
a mismatch between the oxygen supply and oxygen demand
Poor blood supply to an organ is referred to as
ischemia
Chronic stable angina has atherosclerosis as its primary cause, triggered by
by exertion, stress, nicotine, alcohol, coffee, and other SNS stimulants
The pain associated with this type of angina intense but subsides within 15 minutes of either rest or appropriate antianginal drug therapy.
chronic stable angina
Unstable (preinfarction) angina is usually the early stage of progressive coronary artery disease, often ending in an MI in subsequent years. Later, pain may even occur while the patient is at rest.
is also called crescendo angina because pain and attacks are more over time
spasms in the layer of smooth muscle that surrounds atherosclerotic coronary arteries, often occurring at rest and without any precipitating cause, but following a regular pattern, such as the same time of day
is called Vasospastic/Prinzmetal/Variant angina
Nitrates/nitrites, beta blockers, calcium channel blockers (CCBs) are used to treat
angina
1) minimizing the frequency of attacks and decrease the duration and intensity of the anginal pain; (2) improving the patient’s functional capacity with as few adverse effects as possible; and (3) preventing or delaying the worst possible outcome, MI.
Objectives of anginal drug therapy
the mainstay for both the prophylaxis and treatment for angina is
nitrates
the action of isosorbide mononitrate is
long
the action of these nitrates are long and rapid
nitroglycerin and isosorbide dinitrate
what is the rapid acting nitrate
amyl
The MOA of this type of drug dilate constricted coronary arteries to increase the supply of oxygen and nutrients to the heart muscle and all blood vessels, predominantly affecting venous vascular beds. They have a dose-dependent arterial vasodilator effect
nitrates
Adverse effects of nitrates involve cardiovascular system are usually transient
The most common undesirable effect is headache, which generally diminishes soon after the start of therapy. Other cardiovascular effects include tachycardia and postural hypotension.
The rate at which the pacemaker (sinoatrial [SA] node) fires decreases, and the time it takes for the node to recover increases. Slowed conduction through the atrioventricular node and reduce myocardial contractility. Both effects serve to slow the heart rate and reduce myocardial oxygen demand, which aids in the treatment of angina by reducing the workload of the heart
When beta receptors are blocked by beta blockers,
the most effective in the treatment of exertional angina because the usual physiologic effects of an increase in the heart rate and systolic blood pressure that occurs during exercise or stress is blunted
beta blockers
decrease in heart rate, cardiac output, and cardiac contractility, bronchoconstriction, and increased airway resistance are adverse effects of
beta blockers
The adverse effects of these are limited and primarily relate to over expression of their therapeutic effects.
CCBs
