Anti-angina Meds

Question 1

Which drugs has anecdotal evidence of efficacy?

Answer 1

Nitrates

Question 2

Nitrates will do what to the systemic circulation?

Answer 2

1. Venodilation
2. Arteriolar vasodilation
3. Arterial vasodilation

Question 3

Nitrates will effect the coronary circulation by

Answer 3

Increasing the coronary blood flow and reducing the diastolic blood pressure

Question 4

What does nitrates activate? What odes it result in?

Answer 4

It activates Guanylate Cyclase leading to an increase in cGMP

Question 5

Nitrates ultimately is an agent that

Answer 5

Reduce myocardial oxygen demand

Question 6

What is the significance of dose response of oral nitrates?

Answer 6

As we increase nitrate dose, there is a difference in the opening of the veins and arteries.

Capacitance veins have a great effect and will show immediate dilation, conductance arteries will have a gradual widening and resistance artery takes a while for ir to dilate

Question 7

Will nitrates reduce preload and afterload?

Answer 7

Yep

Question 8

What is the bottom line for nitrates to work on dilating coronary arteries?

Answer 8

You need functional smooth muscle cells around the circumference of the artery for coronary dilation

Question 9

Will smaller coronary arteries dilate proportionally more than larger coronary arteries with the administration of nitrates?

Answer 9

Yep

Question 10

Which dilate more with the administration of nitrates: a eccentrically diseased heart or concentrically diseased heart

Answer 10

Eccentrically diseased heart

Question 11

Nitrates tolerance… tell me about it

Answer 11

There are multiple potential mechanism for tolerance one of them is due to the depletion of R-SH but the best way to avoid tolerance with chronic administration is have nitrate free interval

Question 12

when are nitrates contra-indicated?

Answer 12

when patient has taken sildenafil since it also leads to vasodilation

this combination can results in severe hypotension and death

Question 13

what to give to a patient who has been given both sildenafil and nitrates?

Answer 13

receive fluid administration, vasopressors and be monitored closely for hemodynamics

Question 14

sildenafil works by

Answer 14

inhibiting the breakdown of cGMP thus leads to increased levels of it

Question 15

Beta blockers effects (4)

Answer 15

1. reduce heart rate
2. reduce BP
3. reduce contractility
4. increases wall tension in patients with left ventricular dysfunction

Question 16

net effect of beta blockers

Answer 16

reduces myocardial oxygen demand

Question 17

when are beta blockers particularly useful in anti-angina effects?

Answer 17

conditions of heightened SNS activity

Question 18

can coronary blood flow go down with beta blockers?

Answer 18

yep

Question 19

classification of beta blockers (3)

which one is not used for angina?

Answer 19

1. beta-1 selective
2. non-selective
3. combined alpha/beta blockers

• neither non-selective or combined is used

Question 20

some side effects of beta blockers

Answer 20

1. bradycardia
2. aggravation of heart failure
3. fall in HDL

Question 21

are beta blockers used in acute MI?

Answer 21

yea, reduces risk fo sudden death, reacurrent MI and progression to heart failure

Question 22

beta blockers with intrinsic sympathomimetic activity are

Answer 22

not benefitcial

Question 23

which calcium channel blockers have myocardial effects

Answer 23

non-dihydropyridine

Question 24

what is the mechanism of non-dihydro calcium blockers

Answer 24

lenghten the conduction time and prolong the refractoriness of the atrio-ventricular node

Question 25

examples of non-dihydro calcium blockers

Answer 25

1. verapamil | 2. diltiazem

Question 26

mechanism of dihydropyridine calcium blockers

Answer 26

effect on vascular smooth muscle at the concentrations used clinically

Question 27

examples of dihydropyridine calcium blockers

Answer 27

1. amlodopine | 2. nifedipine

Question 28

calcium channel blockers effects (4)

Answer 28

1. reduce HR 2. reduce BP 3. reduce contractility

Question 29

net overall effect of calcium channel blockers

Answer 29

reduced myocardial oxygen demand

Question 30

verapamil and diltiazem in addition to increasing coronary blood flow, lowering coronary resistance, reducing afterload, reducing coronary spasms like all calcium blockers they also

Answer 30

1. reduce HR | 2. reduce contractility

Question 31

adverse effect of verapamil and diltiazem

Answer 31

1. bradychardia | 2. AV block

Question 32

nifedipine adverse effects

Answer 32

1. edema | 2. headache

Question 33

treatment for variant angina

Answer 33

1. calcium channel blocker | 2. long-acting nitrates

Question 34

tailored medical therapy after nitrates: sinus brady

Answer 34

Dihydro CCB

Question 35

tailored medical therapy after nitrates: Sinus tachy

Answer 35

B-blocker

Question 36

tailored medical therapy after nitrates: supraventricular tachy

Answer 36

verapamil and B-blocker

Question 37

tailored medical therapy after nitrates: Afib

Answer 37

verapamil, diltiazem or B-blocker

Question 38

tailored medical therapy after nitrates: L.ventricular dysfunction

Answer 38

B-blocker

Question 39

tailored medical therapy after nitrates: COPD

Answer 39

CCB

Question 40

what should always be part of all anginal patients's regimen

Answer 40

NG sublingual

Question 41

which medication enhances the efficacy of dihydro CCB

Answer 41

B-blockers

Question 42

aspirin in angina treatment: 1. stable angina 2. primary prevention 3. secondary MI prevention 4. unstable angina

Answer 42

1. yes, reduction in adverse CV events 2. recommended for high risk patients 3. yes, reduces both mortality and reinfarction 4. yes, reduction in MI and mortality

Question 43

Aspirin blocks

Answer 43

cyclo-xygenase leading to decreased platelet aggregation

Question 44

aspirin side effects

Answer 44

GI bleeding

Question 45

treatment guideline of aspirin

Answer 45

75-162

Question 46

ranozaline

Answer 46

can inhibit the cardiac late sodium current

Question 47

which ion channel is enhanced in ischemia

Answer 47

late sodium channel

Question 48

late sodium channel actiation has been associated with

Answer 48

intracellular sodium and calcium loading, leading to cellular and reperfusion injury

Question 49

does ranolazine increase QT?

Answer 49

modest increase but there is no increaae in risk for torsade de Pointes

Question 50

ranolazine has multiple drug interactions

Answer 50

yes

Question 51

Class 1 angina meds

Answer 51

1. beta blockers 2. CCB 3. long acting nitrates 4. NG

Question 52

Class IIa angina meds

Answer 52

1. long acting non-dihydro CCB | 2. ranolazine

Question 53

nicorandil, ivabradine and trimetazidine

Answer 53

meds available outside of USA