Anti-anginal Drugs

Question 1

Stable Angina

Answer 1

Exertional Angina
Pre-existing coronary artery occlusion.
Very predictable onset
Pain associated with physical exertion, cold stress, emotional stress
Treat by decrease O2 demand and increase O2 supply

Question 2

Vasospastic Angina

Answer 2

Caused by unpredictable, transient vasospasm of the coronary vessels.
May develop at rest
Treat by decreasing vasospasm, reduce O2 demand

Question 3

Unstable Angina

Answer 3

Caused by recurrent episodes of platelet clots at the site of the plaque
May be associated with MI
Treat by: Inhibit platelet aggregation, decrease O2 demand, Increase O2 supply, inhibit vasospasm

Question 4

Treatment of Angina

Answer 4

Typically directed toward reducing O2 demand

Decrease Ventricular wall stress, cardiac contractility, and heart rate.

Question 5

Nitrovasodilators

Answer 5

Gylceryl Trinitrate: sublingual, buccal, transdermal
Isosorbide Mononitrate: Sustained release, sublingual
Isosorbide Dintrate: Sustained Release formulation, sublingual

Question 6

Nitrovasodilators Mechanism

Answer 6

Vasodilation reduces preload, which will reduce ventricular wall stress and myocardial O2 demand.
NO inhibits platelet aggregation which will help with unstable angina

Question 7

Calcium Channel Blockers

Answer 7

Block L-type “slow” Calcium Channels.
Reduce Influx of Ca++ into vascular muscle
Preferential arteriolar vasodilators vs veins
Reduces Afterload and strain on heart

Question 8

Beta Blockers

Answer 8

Reduce Heart Rate, Contractility, and Afterload (in hypertensive patients)
These three components reduce O2 demand

Question 9

Ranolazine

Answer 9

Anti-Anginal effects independent of reductions in BP and/or HR
Useful as adjunct or alternative therapy
For chronic angina, not acute

Question 9

Ranolazine

Answer 9

Anti-Anginal effects independent of reductions in BP and/or HR
Useful as adjunct or alternative therapy
For chronic angina, not acute