Anti Anginal Drugs

Question 1

What does NBC stand for

Answer 1

Nitrates
Beta Blockers
Calcium Channel Blockers

Question 2

What are the 5 ways to administer nitroglycerin

Answer 2

• Sublingual (spray or tab)
• Transdermal
• Topical
• Injectable
• Oral

Question 3

Why is oral nitroglycerin not ideal

Answer 3

It undergoes major first pass hepatic metabolism, so very little of the drug actually gets into the bloodstream

Question 4

What is the best route for nitroglycerin

Answer 4

Sublingual - ideally the spray

Question 5

What doe nitro do to the veins

Answer 5

Reduces venous return and decreases preload

Question 6

What does nitro do to the arterioles

Answer 6

Drops blood pressure, Decreases resistance, Decreases after load

Question 7

What does nitro do to arterioles

Answer 7

Increases coronary blood flow

Question 8

What are the determinants of O2 requirements

Answer 8

• Heart rate
• Contractility (force of contraction)
• Preload (venous return)
• Afterload (diastolic BP)

Question 9

Effects of nitrates on the O2 determinants

Answer 9

Decreased preload
Decreased Afterload

Question 10

Adverse effects of nitrates

Answer 10

Orthostatic Hypotension
Frequent headaches
Reflex Tachycardia
Tachyphylaxis (tolerance)

Question 11

What are Beta Blockers

Answer 11

Antagonists that block the stimulation of beta adrenergic receptors of the ANS

Question 12

What effects do beta blockers have on the heart

Answer 12

Negative Chronotropic, Inotropic, and dromotropic
Decrease in renin release

Question 13

What effects do beta blockers have on O2 requirement determinants

Answer 13

Decreased heart rate
Decreased contractility
Decreased preload
Decreased afterload

Question 14

Beta 1 Blockers

Answer 14

Metoprolol
Bisprolol
Atenolol

Question 15

Non Specific Beta Blockers

Answer 15

Propanolol
Timolol
Prindolol
Labetalol
Carvediol

Question 16

What are the therapeutic uses for beta blockers

Answer 16

Angina, Hypertension, Arrhythmias, Heart Failure
Migraines
Anxiety
Hyperthyroidism

Question 17

Adverse effects of beta 1 blockers

Answer 17

Bradycardia
Risk of AV block
Heart failure
Hypotension

Question 18

General adverse effects of beta blockers

Answer 18

Fatugue
Nightmares
sexual dysfunction

Question 19

Non specific beta blocker adverse effects

Answer 19

Bronchoconstriction
Masks the symptoms of hypoglycaemia
reduces the release of glucose
Slight increase in peripheral resistance
inhabits lipolysis

Question 20

Why are non specific beta blockers more risky to use

Answer 20

Because they can affect any type of beta receptors, which can lead to higher risk of bronchial effects or metabolic effects

Question 21

What are the 2 classes of calcium channel blockers

Answer 21

• Dihydropyridines
• Non Dihydropyridines

Question 22

Examples of the Dihydropyridines

Answer 22

Amlodipine
Nifedipine

Question 23

2 Groups of Non Dihydropyridines

Answer 23

Benzothiazepines
Phenylalkyamines

Question 24

Example of Phenylalkyamines

Answer 24

Verapamil

Question 25

Example of a Benxothiazepines

Answer 25

Diltiazem

Question 26

Vascular effects of Calcium Channel Blockers

Answer 26

Arterial Vasodilation -> reduced blood pressure Coronary artery vasodilation/reduction of vaso spasms

Question 27

Cardiac effects of calcium channel blockers (non dihydropyridines)

Answer 27

Negative inotropic effect (decreased force of contraction) Decreased heart rate

Question 28

Effects of Calcium Channel blockers on the O2 requirement determinants

Answer 28

Decreased Heart rate Decreased force of contraction Decreased afterload

Question 29

Therapeutic effects of Calcium channel blockers

Answer 29

Angina Hypertension Arrhythmias - Non dihydropyridines

Question 30

Adverse effects of Calcium Channel Blockers

Answer 30

Headaches Flushing Edema of lower limbs orthostatic hypotension constipation -> verapamil