Antanginals Based On Review Flashcards
What is a risk of all vasodilators?
Risk of decreasing coronary flow
Shortened diastole, lowered perfusion pressure during diastole
What is the MOA of nitrates/nitrites?
It increases the release of NO
No stimulates Guanylyl Cycylase= lots of cGMP
Lots of cGMP=Myosin LC RELAXATION
Which does nitroglycerin dilate more: veins or arteries
Large Veins
Uneven vasodilation
Why do nitrites help in angina?
Decreasing myocardial O2 requirement!
(They decrease preload (venous dilation)
Decrease afterload (some arteriole dilation))
Do nitrates cause reflex tachycardia
Oh yeah ⏱
Why is nitroglycerin taken sublingually?
Because if you give it orally, the liver will destroy almost all of it on the “first pass”
This allows for rapid absorption and immediate angina relief
How long does it take for nitrates to kick in
1-3 min
What are the adverse effects of nitroglycerin
Throbbing headaches (big diff b/w diastolic and systolic pressure)
Orthosstatic hypotension
Tachycardia
Can patients use nitroglycerin long term?
No, they will build up tolerance fast
What is “Monday disease”
Guys who make explosives would get headaches and dizziness on Monday and Tuesday, and then by Friday, their symptoms would disappear due to developing tolerance to nitro over the week.
Then by the following Monday, sensitivity is restored and their headaches are back.
What is the IV form of nitro?
Nitroprusside
What is the MOA of calcium channel blockers?
Block calcium channel on membrane of muscle cells
=no ca/calmoduliun to activate myosin LC Kinase
=muscle contraction impossible
What are the 3 main calcium channel blockers discussed in this lecture
Nifedipine (and other dihydropyridines -dipines)
Verapamil
Diltiazem
Which CCB has the MOST effect on vascular smooth muscle
Nifedipine (and other -dipines)
Which CCB has the LEAST effect on vascular smooth muscle
Verapamil
Which CCB has the MOST effect on the heart muscle?
Verapamil
Which CCB has the least effect on the heart muscle?
Nifedipine
Do we give nifedipine for HTN or angina?
HTN ONLY
Strong vasodilation, very little effect on heart
Which calcium channel blocker may cause angina pectoris
Nifedipine due to huge vasodilation and subsequent major drop in diastolic BP
CCBs are good for (Chronic/acute) angina
Chronic
Can we use beta blockers for Prinzmetals angina
NO!!! NO!!! NO!!! They are NOT VASODILATORS
Will beta blockers have any vasodilation
NO**
If B blockers dont have any vasodilation effect, how do they help with angina?
Decrease SNS activity= slower HR and less vasoconstricion
Bradycardia= increased myocardial perfusion time
What are the adverse effects of beta blockers?
Bronchoconstriction!!!!
Increased Triglycerides
Decreased insulin and hypoglycemic response
What does Ranolazine (Ranexa) do?
It is a decreases LV stiffness and improves coronary circulation
Used only when other anti-angina medications dont work
What two conditions are NOT good for beta blockers
Asthma
Diabetes
What kind of antianginal should you avoid if patient has a peptic ulcer 🔥
CCB
Relaxes ALL smooth muscles which slows gastric emptying=ulcer made worse
How do PDE5 inhibitors work?
They inhibit PDE5 lol
This keeps cGMP around which= profound vasodilation in your peepee
What drug do you NEVER EVER combine PDE5 inhibitors with
Nitrates
What drugs do you need to be CAREFUL combining with PDE5 inhibitors
All vasodilators
What are the 2 indications for sildenafil
ED
Pulmonary hypertension
What is the half life of sildenafil (viagra)
4 hours
What is the most interesting side effect of sildenafil (viagra)
Visual impairments including a blue tinge to vision, photophobia or blurred vision
Why cant pilots take viagra writhing 8 hours of flying
Makes white lights look blue= wrong way driver on the runway 👨🏼✈️🛬💥
What makes the new ED drugs different from Viagra?
They are more selective for PDE5 than PDE6 (in retina) = less visual disturbances
What is the difference between Vardenafil (Levitra), Avanafil (Stendra), and Tadalafil (Cialis)?
Vardenafil and Avanafil= Very soon (onset of action within 15 min)
Tadalafil= Tomorrow. (24-36 hr duration of action= spontaneity!)
