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CV II Exam 3 > Anti-Anginal Agents I > Flashcards

Anti-Anginal Agents I Flashcards

1
Q

isosorbide dinitrate

A

nitrate vasodilator

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2
Q

nitroglycerin

A

nitrate vasodilator

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3
Q

non-DHP CCB

A

verapamil and diltiazem

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4
Q

DHP CCB

A

nifedipine
amlodipine
felodipine

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5
Q

-dipines

A

DHP CCBs

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6
Q

clopidogrel

A

antiplatelet

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7
Q

aspirin

A

antiplatlet

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8
Q

heparin

A

anticoag

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9
Q

IIa IIIb inhibitors

A

abciximab
tirofiban
eptifibatide

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10
Q

angina pectoris

A

Sx of IHD

CAD usually the cause

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11
Q

heavy pressing substernal discomfort

-radiates to left shoulder, jaw

A

sensation of angina

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12
Q

typical angina

A

exertional
-induced by exercise and relieved by rest and/or nitroglycerin

ST segment depression

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13
Q

atypical angina

A

at rest

coronary vasospasm episodically reduced coronary flow

transient ST segment elevation

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14
Q

prinzmetal

A

vasospasm

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15
Q

unstable angina

A

rupture of plaque

abrupt decrease in flow

Sx not relieved by 3 nitro in 15 minutes - call 911

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16
Q

angina

A

loss of O2 supply and demand balance

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17
Q

agents that decrease O2 demand

A

beta blockers

CCBs

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18
Q

approach to typical angina

A

decrease O2 demand

  • beta-blocker and aspirin
  • or clopidogrel if ASA contraindicated
  • beta-blocker and aspirin and long acting nitrate
  • sub-lingual nitro - acute attacks
  • ACE inhibitors - patients with DM or left vent dysfunction
  • long acting CCB - DHPs - if beta blocker contraindicated
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19
Q

approach to unstable angina

A

MONA
-morphine, O2, nitro, ASA

and beta blocker or non-DHP CCB if beta blocker CI’d and no LV dysfunction

PCI
CBG
thrombolytics

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20
Q

avoid non-DHP CCB and beta blocker

A

can cause heart block

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21
Q

organic nitrates

A

prodrugs sources of NO
-decrease preload and afterload

mainly - large veins - decreased preload

also dilate coronary arteries (subendocardial region)

22
Q

mechanism of NTG

A

increased guanylyl cyclase and cGMP

-leads to de-P of myosin and relaxation of smooth muscle**

23
Q

isosorbide dinitrate

A

long acting nitrate vasodilator

24
Q

adverse effect of nitrates

A

headaches, facial flush, dizziness, orthostatic hypotension (alcohol worsens)

25
Q

tolerance of nitrates

A

effectiveness diminishes significantly with continued use

need to go 8hr drug-free/day

26
Q

patients on erectile dysfunction drugs

A

contraindicated use of nitrates

sildenafil, tadalafil, vardenafil, cyclic nucleotide

27
Q

right ventricular infarction

A

contraindication for nitrates

28
Q

verapamil

A

non-DHP CCB

-cardiac effects

29
Q

diltiazem

A

non-DHP CCB

-cardiac effects

30
Q

DHPs

A

CCB with predominant vasodilation effects

nifedipine, amlodipine, felodipine

initial vasodilation with reflex tachycardia

31
Q

CCBs in angina

A

block Ca entry through L-type Ca channels (slow)

relax arteriolar smooth m
-decreased afterload and decreased O2 demand**

32
Q

relaxation of arterioles and decreased arterload

A

affect of CCBs

33
Q

cardiac cells

A

fast channels - Na
slow channels - Ca

Ca induces additional SR Ca release

binds troponin - allows contraction

CCB - negative inotropic effect - concurrent decrease in vascular resistance

34
Q

DHPs

A

block channels but don’t effect recovery of channels

-not frequency dependent

35
Q

non-DHPs

A

block channels, delay recovery, and are frequency dependent

decrease rate of SA node depolarization and slow AV node conduction

useful for supraventricular tachyarrhythmias

36
Q

supraventricular tachyarrhythmias

A

non-DHP CCBs

37
Q

all CCBs

A

decrease coronary vascular resistance and increase coronary blood flow

38
Q

DHP

A

slower onset, longer acting drugs

39
Q

non-DHP and betablocker

A

contraindicated

-potential for AV block**

40
Q

CCBs and angina

A

can result in coronary steal

41
Q

constipation

A

verapamil

42
Q

mild to moderate exertional angina

A

beta blockers

43
Q

post MI

A

beta blockers should be used in every patient

44
Q

chronic stable angina

A

beta blocker with long acting nitrate or DHP CCB

45
Q

aspirin

A

decreased mortality in patients with unstable angina

  • reduced incidence of MI and death
  • inhibition of platelet aggreation
46
Q

aspirin mechanism

A

blocks prostaglandin synthesis

-irreversible** inhibition of cyclooxygenase

47
Q

clopidogrel

A

inhibits binding of ADP to platelet receptor
-irreversible inhibition of platelet aggregation

unstable angina, prophylaxis and treatment of TIA and completed stroke

standard treatment for patients undergoing stent placement

48
Q

abciximab

A

IIb/IIIa antibody
-inhibits platelet aggregation

for Tx of unstable angina when angioplasty and atherectomy planned within 24 hours

49
Q

prophylaxis and single attack angina

A

NTG - 1-3min onset and duration of 20-30min

50
Q

chronic stable angina

A

beta blockers, CCBs, long duration nitrates

51
Q

vasospastic angina

A

CCB or nitrates

CV II Exam 3 (21 decks)

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