Anti-anginal & anti-thrombotic

Question 1

Clinical features of CSA

Answer 1

Symptom reversibility
Repetitive attacks
Occurs over months to years

Question 2

Nitrate MOA

Answer 2

Relaxation of vascular SM vasodilation

Venous dilation > arterial –> reduced preload –> reduced O2 consumption

Question 3

two types of nitrates

Answer 3

NTG

isosorbide monoitrate

Question 4

NGT uses / onset / duration of action

Answer 4

angina
onset: 1-3 mins (SL) 30 mins (patch) 60 mins (extended release)
lasts 25 mins (SL) 10-12 hours (patch) 4-8 hours (ER)

Question 5

which natural products interact with hypotensives?

Answer 5

coleus
hawthorne
l-citrulline
NAC
*all major interactions

Question 6

why should combination with sildenafil be avoided with hypotensives?

Answer 6

unsafe hypotension

Question 7

are nitrates more specific to arterial or venous blood vessels

Answer 7

venous

Question 8

isosorbide mononitrate indications and onset

Answer 8

angina pectoris

30-45 mins

Question 9

beta blockers role in therapy

Answer 9

prophylactic
blunts cardiac stimulation
prevents reflex tachycardia**
decreases HR, contractility and BP

Question 10

beta blocker MOA

Answer 10

blocks beta adrenergic receptors

can be selective or non-selective to the heart

Question 11

BB side effects

Answer 11

bradycardia, heart block, HA, fatigue, exercise intolerance, hypotension, erectile dysfunction

Question 12

avoid use of BB with ______

Answer 12

intrinsic sympathomimetic activity (ISA aka partial agonist)

• Pindolol
• Acebutolol

Question 13

BB 1-3 where are they found?

Answer 13

beta-1: heart
beta-2: lung mostly, but also heart
beta-3: adipose tissue, and heart

Question 14

T/F at high doses, selective beta blockers become non-selective

Answer 14

true

Question 15

why do you need to taper off BB’s gradually?

Answer 15

abrupt discontinuation can lead to reflex tachycardia

Question 16

what are the cardioselective B1 competitive antagonist BB

Answer 16

Metoprolol, Atenolol

Question 17

indications for metoprolol

Answer 17

MI, CHF, angina, HTN

all same for Atenolol except CHF

Question 18

avoid metoprolol in ppl with

Answer 18

heart block or severe bradycardia

Question 19

onset / duration of metoprolol

Answer 19

1 hr

3-6 hours (IR), 24 hrs (ER)

Question 20

Atenolol onset, duration of action

Answer 20

<1 hour
12-24 hours
metabolism: limited hepatic

Question 21

interactions with atenolol

Answer 21

apple (major)

Question 22

what BB has a higher concern of mortality, except for mortality benefit in silent ischemia

Answer 22

atenolol

Question 23

what is the non-selective B-1 & B-2 Beta blocker

Answer 23

propranolol

Question 24

indications for propranolol

Answer 24

MI (treat and prevent), HTN, angina, migraine prophylaxis, supraventricular arrhythmias

Question 25

avoid propranolol in ppl with ____ and ____

Answer 25

heart block and severe brachycardia

Question 26

onset and duration of propranolol

Answer 26

1-2 hours | 6-12 hrs (IR) 24-27 (ER)

Question 27

propranolol interacts with what natural products

Answer 27

indian snakeroot | st john's wort

Question 28

what is the nonselective BB with alpha-1 adrenergic blockade activity

Answer 28

Carvedilol

Question 29

what natural product interacts with carvedilol

Answer 29

grapefruit --> increases bioavailability

Question 30

which beta blockers are more likely to interact with beta-agonists used in asthma

Answer 30

nonselective

Question 31

which beta blocker covers both beta and alpha receptors

Answer 31

carvedilol

Question 32

calcium channel blockers role in therapy

Answer 32

prophylactic tx decrease BP dilates coronary blood vessels dilates peripheral blood vessels

Question 33

CCB MOA

Answer 33

blocks calcium influx leading to relaxation of cardiac and SMs

Question 34

side effects of CCB

Answer 34

tachycardia** edema** (HA, fatigue, exercise intolerance, hypotension)

Question 35

CCB agents differ based on their selectivity towards which type of receptors

Answer 35

DHP (dihydropyridine), predominately found in periphery

Question 36

CCBs are a 2nd line tx in angina but a 1st line tx in what

Answer 36

variant angina

Question 37

DHP CCB Amlodipine indications

Answer 37

HTN, chronic stable angina, variant angina, disorder of cardiovascular system

Question 38

amlodipine interacts with

Answer 38

lots of different drugs! esp. statins cholea grapefruit st john's wort

Question 39

nonDHP CCB Diltiazem (Benzothiazepine CCB) indications

Answer 39

atrial arrhyythmias, HTN, SVT, angina

Question 40

avoid Diltiazem with what conditions

Answer 40

hypotension, LVEF <30%, AV block, sick-sinus syndrome, certain arrhythmias

Question 41

how do the MOA's differ between DHP and non-DHP CCBs?

Answer 41

DHPs are working at periphery non-DHP working at heart non-DHP has higher rate of hospitalization due to heart failure

Question 42

why are CCBs more likely to have drug interactions with other therapeutic moieties

Answer 42

bc they inhibit CYPs which makes them susceptible to drug interactions

Question 43

Clopidogrel belongs to which drug category

Answer 43

Anti-platelet

Question 44

MOA of clopidogrel

Answer 44

irreversibly blocks P2Y component of ADP receptors on platelet surface prevents activation of GPIIb/IIIa receptor complex reduces platelet aggregration

Question 45

do drug interactions affecting CYP enzymes tend to increase or decrease the effectiveness of P2Y inhibitors (ex Clopidogrel)

Answer 45

it depends, you cannot make a generalization about it

Question 46

what is INR

Answer 46

international normalized ratio of prothrombin time, we target between 2 and 3