AnginaTreatment Flashcards
What are common adverse effects of nitrates?
headaches due to meningeal vessel dilation and severe hypotension
What is a major drug-drug interaction with nitrates?
sildenafil (viagra) is a PDE inhibitor so prevents cGMP metabolism. Nitrates produce cGMP. Results in profound hypotension and myocardial ischemia.
Where do non-dihydropyridines act? What are examples of these drugs?
Verapamil > Diltiazem. they are cardioselective and have direct effects on heart. Decrease HR, contractility and slow AV conduction. Can reverse vasospasm.
Where do dihydropyridines act? What are examples of these drugs?
nifedipine, felodipine, etc. More potent vasodilators with a reflex cardiac stimulation. Could combine with a beta blocker to reduce reflex stimulation.
What effects would you expect when combining non-dihydropyridines with beta-blockers?
absolute contraindication because both will slow rate of heart conduction and can cause SA node blocks.
What is ranolazine? What is its mechanism? What are adverse effects?
Metabolic modulator. Partial fatty acid oxidase inhibitor increasing glucose oxidation and efficiency. late Na channel inhibitor. No effect on HR or BP. Useful for chronic stable angina in combination with amlodapine, BBs or nitrates. Very expensive. Dizziness, headaches. Increases digoxin concentrations so contraindicated.
What is a severe adverse effect of nitrites?
methemoglobinemia. Note that nitrates do not cause this, only nitrites. Also, it is sometimes induced intentionally as an antidote to cyanide poisoning.
What effect does nitroglycerin have on cardiac force?
it increases it reflexively
What is diltiazem? What is its mechanism?
Very similar to verapamil. Ca channel blocker. that is cardiospecific.
Why do young patients tend to not like Beta blockers?
they affect athletic performance by blocking exercise induced tachycardia.
What common advesre effect do nitroglycerin and prozosin have in common?
orthostatic hypotension is common in both alpha blockers and nitrates
Which of the following drugs often causes tachycardia: Clonidine, diltiazem, isosorbide dinatrate, proranolol, verapamil?
isosorbide dinatrate. All nitrates can cause reflex tachycardia due to the drop in BP
