Anti-Anginal Drugs

Question 1

What are the organic nitrates? How do they work?

Answer 1

• amyl nitrate, nitroglycerin, isosorbide mononitrate, isosorbide dinitrate
• release nitrite ion –> increase in NO –> increase in cGMP –> vasodilation (venous>arteriolar) and redistribution to ischemic areas; decrease platelet aggregation

Question 2

What is the use of organic nitrates in angina? What else can they be used for?

Answer 2

• in angina they decrease preload and after load

- can also be used in cyanide poisoning

Question 3

What are the adverse side effects of organic nitrates?

Answer 3

• HEADACHE, increase in heart rate and contractility, reflex tachycardia, orthostatic hypotension, flushing, methemoglobin
• tolerance causes Monday Disease: tachycardia, dizziness, and headache when re-exposed to nitrates

Question 4

What is the adjunct therapy for treatment of refractory angina? (modifies metabolism) Any adverse effects?

Answer 4

Ranolazine is a partial fatty-acid oxidation inhibitor –> decreases late Na current and calcium overload
-causes long QT and testicular toxicity (no effects on HP, BP, inotropy/chronotropy

Question 5

Which slow-type calcium channel blocker has the strongest effects of vessels? In which condition is it better for a patient than diltiazem or verapimil?

Answer 5

-nifedipine; better for patients with hypertension

Question 6

What is the common ending for slow-type calcium channel blockers? Name some and how they work.

Answer 6

• dipine: amiodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine
• block slow Ca channels –> decrease in intracellular calcium –> relax arteriolar smooth muscle and decrease platelet aggregation

Question 7

What are some adverse side effects of slow-type Ca channel blockers?

Answer 7

-reflex tachycardia, hypotension, dizziness, constipation, edema

Question 8

In which condition is verapimil, then diltiazem, then nifedipine better for the patient?

Answer 8

• PVST, AFib/Aflutter

- verapimil has the strongest effect on the heart!

Question 9

What do verapimiL and diLtiazem do? What are some of their adverse side effects?

Answer 9

• they block L-type Ca channels –> decrease in intracellular calcium –> myocardial cells relax –> decrease in SA/AV activity/contractility
• side effects: decrease in HR and BP, AV block, constipation, dizziness edema, decreased insulin, toxicity with digoxin
• NO reflex tachycardia though!

Question 10

When is use of verapimil and diltiazem contraindicated?

Answer 10

-SA/AV node conduction abnormal and in CHF

Question 11

When is nitroprusside used? Why can’t it be taken orally?

Answer 11

• used as IV vasodilator: release of NO –> arterioles and venules dilate
• used in hypertensive crisis, acute MI, and aortic dissection to decrease afterload and preload
• can’t be taken orally b/c then it’s metabolized to cyanide; also half-life is in minutes