Anti-Anginal Drugs

Question 1

What are common nitrates? what is the MOA and common side effects? what is it clinically used for?

Answer 1

*Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate
*MOA: release of nitric oxide to increase cGMP to relax vascular smooth muscle
*SE: headache, orthostatic hypotension, flushing, tachycardia, nausea
* used for acute angina relief, HF, acute coronary syndromes

Question 2

What are common beta blockers? what is the MOA and common side effects? what is it clinically used for?

Answer 2

*Metoprolol, Atenolol
*MOA: inhibit beta adrenergic receptors which decrease HR and contractility
*SE: fatigue, bradycardia, hypotension, bronchospasm
*used for angina, HTN, arrhythmias, and HF

Question 3

What are common calcium channel blockers? what is the MOA and common side effects? what is it clinically used for?

Answer 3

*Nifedipine, Verapamil, Diltiazem
*MOA: inhibit calcium influx which relaxes vascular smooth muscle and decreases HR and BP
*SE: dizziness, headache, flushing, edema, constipation!!
*used for variant angina, HTN, and arrhythmias, NOT FOR HF due to negative ionotropic effect

Question 4

What is Ranolazine? what is the MOA and common side effects? what is it clinically used for?

Answer 4

*MOA: modulates sodium and calcium channels in myocardial oxygen demand
*dizziness, headache, constipation, QT interval prolongation
*used for chronic angina when 1st line treatments are ineffective

Question 5

what are PT considerations for nitrates?

Answer 5

Nitrates can cause headaches, dizziness, and flushing.
Nitrates reduce preload and dilate coronary arteries therefore all patients should have nitroglycerin on hand to treat acute angina attacks

Question 6

What are PT considerations for beta blockers

Answer 6

*Fatigue, SOB, Low BP and HR
*cardioselective B1 blockers are best and Beta blockers with intrinsic sympathomimetic activity should be avoided

Question 7

what is the preferred treatment for vasospastic angina?

Answer 7

calcium channel blockers

Question 8

what sodium channel blocker is typically used in patients who have failed other therapies for stable angina?

Answer 8

Ranolazine

Question 9

what is the MOA of Ranolazine?

Answer 9

inhibits sodium current and calcium overload which improves diastolic function

Question 10

Compare Verapamil and Nifedipine

Answer 10

Verapamil: affects the myocardium, not indicated for HF!!
Nifedipine: greater affect on smooth muscle in blood vessels, can cause reflex tachycardia

Question 11

At therapeutic doses, what are the two major effects of nitroglycerin?

Answer 11

1. Causes dilation of the large veins, resulting in pooling of blood in the veins. Diminishes preload (venous return to the heart) and reduces the work of the heart
2. dilates the coronary vasculature, providing an increased blood
   supply to the heart muscle
   DECREASED OXYGEN CONSUMPTION FROM DECREASED CARDIAC WORK

Question 12

what drug is contraindicated to be combined with nitrates ?

Answer 12

Sildenafil (Viagra) potentiates the action of nitrates