Antanginals Based On Review

Question 1

What is a risk of all vasodilators?

Answer 1

Risk of decreasing coronary flow

Shortened diastole, lowered perfusion pressure during diastole

Question 2

What is the MOA of nitrates/nitrites?

Answer 2

It increases the release of NO

No stimulates Guanylyl Cycylase= lots of cGMP

Lots of cGMP=Myosin LC RELAXATION

Question 3

Which does nitroglycerin dilate more: veins or arteries

Answer 3

Large Veins

Uneven vasodilation

Question 4

Why do nitrites help in angina?

Answer 4

Decreasing myocardial O2 requirement!

(They decrease preload (venous dilation)

Decrease afterload (some arteriole dilation))

Question 5

Do nitrates cause reflex tachycardia

Answer 5

Oh yeah ⏱

Question 6

Why is nitroglycerin taken sublingually?

Answer 6

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

Question 7

How long does it take for nitrates to kick in

Answer 7

1-3 min

Question 8

What are the adverse effects of nitroglycerin

Answer 8

Throbbing headaches (big diff b/w diastolic and systolic pressure)

Orthosstatic hypotension

Tachycardia

Question 9

Can patients use nitroglycerin long term?

Answer 9

No, they will build up tolerance fast

Question 10

What is “Monday disease”

Answer 10

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.

Question 11

What is the IV form of nitro?

Answer 11

Nitroprusside

Question 12

What is the MOA of calcium channel blockers?

Answer 12

Block calcium channel on membrane of muscle cells

=no ca/calmoduliun to activate myosin LC Kinase

=muscle contraction impossible

Question 13

What are the 3 main calcium channel blockers discussed in this lecture

Answer 13

Nifedipine (and other dihydropyridines -dipines)

Verapamil

Diltiazem

Question 14

Which CCB has the MOST effect on vascular smooth muscle

Answer 14

Nifedipine (and other -dipines)

Question 15

Which CCB has the LEAST effect on vascular smooth muscle

Answer 15

Verapamil

Question 16

Which CCB has the MOST effect on the heart muscle?

Answer 16

Verapamil

Question 17

Which CCB has the least effect on the heart muscle?

Answer 17

Nifedipine

Question 18

Do we give nifedipine for HTN or angina?

Answer 18

HTN ONLY

Strong vasodilation, very little effect on heart

Question 19

Which calcium channel blocker may cause angina pectoris

Answer 19

Nifedipine due to huge vasodilation and subsequent major drop in diastolic BP

Question 20

CCBs are good for (Chronic/acute) angina

Answer 20

Chronic

Question 21

Can we use beta blockers for Prinzmetals angina

Answer 21

NO!!! NO!!! NO!!! They are NOT VASODILATORS

Question 22

Will beta blockers have any vasodilation

Answer 22

NO**

Question 23

If B blockers dont have any vasodilation effect, how do they help with angina?

Answer 23

Decrease SNS activity= slower HR and less vasoconstricion

Bradycardia= increased myocardial perfusion time

Question 24

What are the adverse effects of beta blockers?

Answer 24

Bronchoconstriction!!!!

Increased Triglycerides

Decreased insulin and hypoglycemic response

Question 25

What does Ranolazine (Ranexa) do?

Answer 25

It is a decreases LV stiffness and improves coronary circulation Used only when other anti-angina medications dont work

Question 26

What two conditions are NOT good for beta blockers

Answer 26

Asthma Diabetes

Question 27

What kind of antianginal should you avoid if patient has a peptic ulcer 🔥

Answer 27

CCB | Relaxes ALL smooth muscles which slows gastric emptying=ulcer made worse

Question 28

How do PDE5 inhibitors work?

Answer 28

They inhibit PDE5 lol This keeps cGMP around which= profound vasodilation in your peepee

Question 29

What drug do you NEVER EVER combine PDE5 inhibitors with

Answer 29

Nitrates

Question 30

What drugs do you need to be CAREFUL combining with PDE5 inhibitors

Answer 30

All vasodilators

Question 31

What are the 2 indications for sildenafil

Answer 31

ED Pulmonary hypertension

Question 32

What is the half life of sildenafil (viagra)

Answer 32

4 hours

Question 33

What is the most interesting side effect of sildenafil (viagra)

Answer 33

Visual impairments including a blue tinge to vision, photophobia or blurred vision

Question 34

Why cant pilots take viagra writhing 8 hours of flying

Answer 34

Makes white lights look blue= wrong way driver on the runway 👨🏼‍✈️🛬💥

Question 35

What makes the new ED drugs different from Viagra?

Answer 35

They are more selective for PDE5 than PDE6 (in retina) = less visual disturbances

Question 36

What is the difference between Vardenafil (Levitra), Avanafil (Stendra), and Tadalafil (Cialis)?

Answer 36

Vardenafil and Avanafil= Very soon (onset of action within 15 min) Tadalafil= Tomorrow. (24-36 hr duration of action= spontaneity!)