Anti-Anginal Flashcards
Nitroglycerin and Isosorbide are what class of drugs?
Nitrates & Nitrites
MOA for Nitrates, Nitrites?
Vasodilation via NO –> cGMP –> uneven vasodilation (veins > arterioles) –> decreased preload > afterload
DOC for any acute anginal attack?
Nitroglycerin and Isosorbide.
Decreased myocardial O2 requirements
T or F: nitrates relax all smooth muscles?
TRUE
Why is sublingual the preferred form of Nitrates?
Avoids hepatic destruction (due to high first pass metabolism), rapid absorption, immediate relief
Adverse effects of Nitrates/Nitrites?
Throbbing HA (vasodilation in brain) Tachycardia, Orthostatic hypotension
IF you take nitro often, what will happen?
Tolerance or marked reduction to drugs effects
T or F: Calcium channel blockers relax all smooth muscles that depend on calcium for normal resting tone and contraction?
TRUE
Verapamil, Diltiazem, and Nifedipine are what drug class?
Ca Chanel Blockers
Verapil has greater effect on vascular smooth muscle or cardiac muscle?
Cardiac muscle (depress SA/AV nodes)
Niedipine has greater effect on vascular smooth muscle or cardiac muscle?
Vascular smooth muscle (cause vasodilation and reflex tachycardia)
Why is Nifedipine indicated only in HTN, not angina?
May provoke angina attacks
What anti-anginal class is better for chronic angina tx and not immediate angina relief?
Ca Channel Blockers
What Ca channel blocker will have equal effects on vascular smooth muscle, cardiac muscle, vasodilation, reflex tachycardia, depression of SA/AV node function
Diltiazem
Nifedipine can lead to what harmful effect?
Increased development of MI
rapid hypotension –> baroreflex –> increased cardiac workload –> ischmia
Verapamil and diltiazem can lead to what harmful effect?
Serious cardiac depression (from SA/AV node depression)
B-blockers have 3 CV effects on what 3 organs?
- Heart (decrease CO)
- Kidneys (decrease renin)
- CNS (decrease sympathetic vasomotor tone
How do B-blockers provide anginal relief?
Decrease sympathetic tone –> cardiac contractility –> myocardial O2 demand
T or F: Beta agonists are ineffective in producing coronary vasodilation?
TRUE
Bronchoconstriction, increased plasma TGs, decreased insulin, hypoglycemia response, and CNS side-effects are SE of what class of drugs?
B-blockers
Why might B-blockers be harmful in tx of variant angina?
B/c slow HR and prolonged ejection will increase LV EDV and increase myocardial O2 requirement
What is a new medication that is a last ditch effort for angina?
Ranolazine (works by a different mechanism, PFOX, inhibitor)
What is the preferred tx for variant or angiospastic angina?
Nitrates and CCB
B-blocks will not dilate spastic coronary vessels
Goals of anti-anginal therapy? (2)
Increase exercise tolerance
Decrease frequency and duration or myocardial ischemia
What group of medications will have the best effect on tx of angina?
Various combos of 3 major drug classes
What is the tx for Nitrate induced reflex tachycardia?
cardio specific CCB or B-blocker + vasodilator
Most preferred drugs angina w/ concomitant for asthma?
CCB, nitrate or nitrite
Most preferred drugs angina w/ concomitant for DM?
CCB, nitrate or nitrite
Most preferred drugs angina w/ concomitant for HF?
Nitrate or nitrite
Most preferred drugs angina w/ concomitant for HTN?
B-blocker, CCB
Most preferred drugs angina w/ concomitant for peptic ulcer?
B-blocker, Nitrate or nitrite
What drug is selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5)?
Sildenafil
Sildenafil is used in the tx of what 2 diseases?
ED
Pulmonary HTN
When is max concentration reached for Sildenafil?
3-120 minutes
What is the half life of sildenafil?
4 hours
What is Sildenafil metabolized by?
CYP3A4 > CYP2C9
Visual impairments: transient blue color tinge to vision, photophobia, or blurred vision are SEs of what drug?
Sildenafil
Sildenafil is contraindicated in what populations?
- Pregnant
- Lactating women
- Infants/children
- Current nitro use (any form, = increased vasodilation)
- Current a-blocker use (= increased vasodilation)
What juice should you avoid if taking Sildenafil?
Grapefuit
What two drugs are more selective for PDE6 vs PDE5? What does this mean for SEs?
Vardenafil, Tadalfil
Decreased retinal sx (less blue tinge to vision)
Will vardenafil allows for an erection sooner or later than if using sildenafil?
Sooner
V = “V”ery soon
What ED medication allows for more spontaneity?
Tadalafil
(T = good for “T”omorrow
Sildenafil, Tadalafil and Vardenafil are what class of drugs?
Phosphodiesterase type 5/6 inhibitors
Originally anti-anginal med, but more effective at tx ED
