Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm > Anti-Anginal > Flashcards

Anti-Anginal Flashcards

1
Q

Classical angina

A
  1. occurs if the coronary artery is narrowed
  2. the reduced blood flow through narrowed arteries can’t meet the increased O2 demand–>
  3. Symptoms occur with increased emotional or physical exertion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Variant Angina aka Prinzmetal’s angina

A
  1. results from a reversible spasm of large coronary arteries, usually at the site of atherosclerotic plaque
  2. can occur at rest or irrespective of the amount of physical or emotional exertion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

acute coronary syndrome aka unstable angina

A
  1. characterized by increased frequency and severity as a result of combo of atherosclerotic plaques and vasospasm
  2. symptoms occur even at rest
  3. might signal an impending MI–>treat as medical emergency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2 strategies for treatment of angina

A
  1. increase O2 delivery: Nitrates & Ca Channel Blockers
  2. Reduce O2 requirement: beta blockers
  3. anti platelet drugs (i.e. low dose aspirin, abciximab) are also used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which anti anginal meds work to increase Oxygen delivery to tissues?

A

Nitrates & Calcium Channel Blockers (CCB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which anti anginal meds work to reduce the oxygen requirement?

A

beta adrenergic blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ranolazine

A

a newer drug that works to increase the efficiency of oxygen utilization by partial fatty acid oxidation inhibitors (pFOX inhibitors)

  1. a pFOX inhibitor (partial fatty acid oxidation inhibitor) in myocardium
  2. primary mechanism of action involves reduced contractility
  3. action results from blockade of a late sodium current that facilitates calcium entry via the sodium-calcium exchanger
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Examples of Nitrates

A
  1. Nitroglycerine (GTN)
  2. Isosorbide dinitrate
  3. Isosorbide mononitrate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nitrates

A
  1. powerful vasodilators
  2. act by releasing NO
  3. NO–> smooth muscle relaxation
  4. effectiveness due to action on capacitance vessels to reduce cardiac pre-load: Dilation of collateral coronary vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nitrates MOA

A
  1. NO formation is triggered by Ach, Bradykinin, histamine & serotonin
  2. NO activates Guanylyl Cyclase (GC) to form cGMP–> smooth muscle relaxation
  3. Contraction of vascular smooth muscle is triggered by influx of calcium
  4. . Ca combines with calmodulin & converts enzyme myosin light chain kinase to its active form (MLCK)
  5. MLCK phosphorylates the myosin light chains–>initiates interaction btw myosin & actin
  6. Nitrates dephosphorylate Myosin light chains to prevent their interaction with actin
  7. phosphodiesterase breaks down cGMP. a phosphodiesterase inhibitor (i.e. Sildenafil) results in an increase in the amount of cGMP–>more dephospho rylation of MLC–>more muscle relaxation

Combining nitrates with sildenafil–>sudden severe hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sildenafil

A

phosphodiesterase inhibitor

phosphodiesterase breaks down cGMP. a phosphodiesterase inhibitor (i.e. Sildenafil) results in an increase in the amount of cGMP–>more dephospho rylation of MLC–>more muscle relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Glyceryl trinitrate (GTN)

delivery?

A

aka nitroglycerine

  1. given sublingually to avoid 1st pass metab; also rapidly absorbed
  2. also available in transdermal patch & via IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do nitrates work?

Any other uses?

A

they decrease the cardiac preload by preferentially dilating veins

Other uses: cyanide poisoning (sodium nitrite, amyl nitrite with sodium thiosulfate)
NITRITE used in cyanide bc converts Hb to MetHb, which has higher affinity for cyanide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Adverse effects of nitrates

A
  1. severe headache (from vasodilation of extracerebral bv)
  2. Tolerance occurs with long term use (need higher doses)
  3. Postural hypotension & reflex tachycardia
  4. Methemoglobinemia caused by NITRITES, not nitrates

“monday disease” in production of substances involving nitrates is an example of the tolerance (build it up over the week) & the symptoms (headache)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nitrates have an interaction with? How?

A

Sildenafil (viagra)

  1. these agents inhibit a phosphodiesterase isoform (PDE5) that metabolizes cGMP in smooth muscle
  2. the increased cGMP in erectile smooth muscle relaxes it, allowing for greater inflow of blood & more effective & prolonged erection
  3. this effect also occurs in vascular sm. as a result the combo of nitrates (via increase in cGMP production) & a PDE5 inhibitor (through decreased breakdown of cGMP) –> synergistic relaxation of vascular sm with potentially dangerous HYPOTENSION & inadequate perfusion of critical organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Calcium Channel Blockers block what type of channel? where is it located?

A

CCB block voltage-gated L-type calcium channels in cardiac & smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Examples of CCB

A

a) Dihydropyridines (DHP):
1. nifedipine, amlodipine, nicardipine, nimodipine
b) Verapamil, diltiazem

18
Q

Examples of Dihydropyridines (DHP)

A
  1. nifedipine
  2. amlodipine
  3. nicardipine
  4. nimodipine
19
Q

Important differences in vascular selectivity between CCB

A

in general, DHPs have a greater ratio of vascular smooth muscle effects compared to cardiac effects than either diltiazem or verapamil

20
Q

Nimodipine is particularly selective for

A

cerebral blood vessels–>used to treat subarachnoid hemorrhage

21
Q

Verapamil & Diltiazem function & use

A

block calcium-dependent conduction in the AV node & are used to treat AV nodal arrhythmias

22
Q

How do CCB work to treat angina?

A

They decrease both preload and after load–> decreasing workload on the heart!

23
Q

Nifedipine

  1. what is it?
  2. Effects?
  3. Use?
  4. ADR?
A
  1. mainly arteriolar vasodilator
  2. minimal effect on cardiac conduction or HR–>NOT USED FOR ARRHYTHMIAS
  3. useful to treat varying angina
  4. ADR:
  5. flushing
  6. headache
  7. hypotension
  8. peripheral edema

All the ADR are results of the vasodilation

24
Q

ADR of Nifedipine

A
  1. flushing
  2. headache
  3. hypotension
  4. peripheral edema

All the ADR are results of the vasodilation

25
Q

Verapamil

What? Use? Interactions/toxicities?

A

More selective for cardiac calcium channels (but will also affect bv)

  1. slows cardiac conduction
  2. decreases HR & O2 demand
  3. causes more negative inotropic effect than nifedipine
  4. Weaker vasodilator than nifedipine–DIP always more powerful
  5. Drug interaction: with digoxin (increases digoxin levels)
26
Q

Diltiazem

A

same as verapamil–More selective for cardiac calcium channels (but will also affect bv)

  1. has specific coronary vasodilating effect relieving coronary vasospasm
  2. particularly useful in variant angina
  3. ADR: low
27
Q

ADR of CCB (generally)

A
  1. cause hypotension due to vasodilation
  2. peripheral edema
  3. overdose leads to cardiac arrest (bc blocked channels–> decreased FOC), bradycardia, AV block & Heart Failure
28
Q

What condition is contraindicated against CCB?

A

Heart Failure! IN heart failure the cardiac output isn’t sufficient to meet the body’s demands. CCB will further decrease the heart’s FOC–> further decreasing it’s CO.

29
Q

How are Beta blockers used to treat angina?

A
  1. work by opposing the action of adrenaline on the heart
  2. block B1 receptors present in the heart–> results in unopposed alpha effects–>vasoconstriction
  3. results in a decrease in HR, BP & contractility
  4. this decreases the myocardial oxygen requirements at REST & DURING EXERCISE
  5. they do NOT HAVE ANY EFFECT ON MYOCARDIAL O2 SUPPLY!
  6. they are used in combo with other anti-anginal drugs
    ie beta blockers + nitrates bc nitrates –>vasodilation + reflex tachycardia but the beta blockers will help prevent the tachycardia
30
Q

When are beta blockers contraindicated in treating angina

A

in vasospastic angina, bc beta blockers will cause further vasoconstriction

block B1 receptors present in the heart–> results in unopposed alpha effects–>vasoconstriction

31
Q

DOC in acute relief of symptoms in all types of angina

A

Nitrates

32
Q

What is used as prophylactic therapy in vasospastic/variant/Prinzmetal’s angina?

A

Ca channel blockers

they’re also useful in angina of effort

33
Q

When should you use beta blockers to treat angina?

A

ONLY for prophylaxis of angina. They’re effective in preventing EXERCISE-INDUCED angina

34
Q

Nitrates have a preference for?

A

veins

35
Q

How do nitrates treat angina?

A

release NO–>sm relaxation through activation of cGMP–> ultimate reduction in preload

36
Q

How do you overcome the reflex tachycardia associated with nitrates?

A

Give them in conjunction with beta blockeres

37
Q

Nifedipine has a preference for?

A

arteries

38
Q

Nimodipine has a preference for

A

cerebral blood vessels

39
Q

decreases HR, BP & contractility

A

beta blockers

reducing these–>decreases myocardial oxygen requirements at rest & during exercise

40
Q

blocks AV nodal conduction

A

verapamil & diltiazem

41
Q

abciximab

A

anti platelet effect; used like aspirin in treatment of angina

42
Q

reduces contractility by blocking late sodium current that facilitates calcium entry via the sodium-calcium exchanger

A

Ranolazine

Pharm (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions