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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
tolerance of nitrates
effectiveness diminishes significantly with continued use need to go 8hr drug-free/day
26
patients on erectile dysfunction drugs
contraindicated use of nitrates sildenafil, tadalafil, vardenafil, cyclic nucleotide
27
right ventricular infarction
contraindication for nitrates
28
verapamil
non-DHP CCB -cardiac effects
29
diltiazem
non-DHP CCB -cardiac effects
30
DHPs
CCB with predominant vasodilation effects nifedipine, amlodipine, felodipine initial vasodilation with reflex tachycardia
31
CCBs in angina
block Ca entry through L-type Ca channels (slow) relax arteriolar smooth m -decreased afterload and decreased O2 demand**
32
relaxation of arterioles and decreased arterload
affect of CCBs
33
cardiac cells
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
DHPs
block channels but don't effect recovery of channels | -not frequency dependent
35
non-DHPs
block channels, delay recovery, and are frequency dependent decrease rate of SA node depolarization and slow AV node conduction useful for supraventricular tachyarrhythmias
36
supraventricular tachyarrhythmias
non-DHP CCBs
37
all CCBs
decrease coronary vascular resistance and increase coronary blood flow
38
DHP
slower onset, longer acting drugs
39
non-DHP and betablocker
contraindicated | -potential for AV block**
40
CCBs and angina
can result in coronary steal
41
constipation
verapamil
42
mild to moderate exertional angina
beta blockers
43
post MI
beta blockers should be used in every patient
44
chronic stable angina
beta blocker with long acting nitrate or DHP CCB
45
aspirin
decreased mortality in patients with unstable angina - reduced incidence of MI and death - inhibition of platelet aggreation
46
aspirin mechanism
blocks prostaglandin synthesis | -irreversible** inhibition of cyclooxygenase
47
clopidogrel
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
abciximab
IIb/IIIa antibody -inhibits platelet aggregation for Tx of unstable angina when angioplasty and atherectomy planned within 24 hours
49
prophylaxis and single attack angina
NTG - 1-3min onset and duration of 20-30min
50
chronic stable angina
beta blockers, CCBs, long duration nitrates
51
vasospastic angina
CCB or nitrates

CV II Exam 3 (21 decks)

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