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CPR 1st half > Anti-anginal Drugs > Flashcards

Anti-anginal Drugs Flashcards

1
Q

4 types of drugs used to treat angina

A

b blockers, ca ch blockers, others (2), and organic nitrates

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2
Q

organic nitrates used to treat angina

A

nitroglycerin
isosorbide dinitrate
isosorbide 5 mononitrate

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3
Q

b blockers used to treat angina

A

propanolol, sotalol, atenolol

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4
Q

ca ch blockers used to treat angina

A

verapimil
diltiazem
nifedipine
nimodipine

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5
Q

two other drugs for angina

A

trimetazidine

ranolazine

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6
Q

stable angina

A

deep, poorly localized chest arm discomfort associated with stress/exertion
no serum changes or necrosis
treat with rest and nitroglycerin

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7
Q

variant (prinzmetal) angina

A

at REST, due to transient increases in coronary tone/vasospasms at site of atherosclerotic change
*ST elevations

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8
Q

unstable angina

A

atleast one of the following

1) at rest, >20 min
2) severe and new onset (1 mo)
3) crescendo pattern (more frequent, severe, prolonged)

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9
Q

NSTEMI

A

form of unstable angina, without ST elevation

not fully occluded

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10
Q

AMI (acute Mi)

A

acute total thrombotic occlusion of coronary artery

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11
Q

angina

A

ischemic heart disease symptom, substernal discomfort (rarely pain) that can extend to left arm/shoulder/jaw

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12
Q

what is angina due to?

A

imbalances in oxygen demand-supply –> ischemia

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13
Q

what does unstable angina usually feature?

A

ruptured coronary atherosclerotic plaque with platelet aggregation –> less BF

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14
Q

BF in coronary circulation

A

only flows in LV coronaries during diastole
in systole, sub endocardium P>subepicardium P so endo need more time to fill
since RV has smaller forces, RV perfusion continues through diastole AND systole

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15
Q

Ca2+ induces….

NO induces…

A

vascular contraction

vasodilation

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16
Q

trimetazidine

A

FA oxidation inhibitor –> enhances glucose oxidation by preventing ATP decrease –> myocardium can function well despite O2 decline

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17
Q

what drug is a FA oxidation inhibitor? effects?

A

trimetazidine
increases coronary BF, delays ischemia, does not affect HR
better LV function

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18
Q

ranolazine

A

inhibits late inward Na current in heart –> reduces wall tension and less O2 demand
DONT use with liver disease or CYP3A inhibitors

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19
Q

why not use ranolazine with CYP3A inhibitors? or liver disease?

A

it is metabolized by CPY3A

increased QT with liver disfunction

20
Q

what drug inhibits late inward Na channel in heart?

A

ranolazine

21
Q

organic nitrates

A

act on vessels, mostly venous!
release NO
oral/inhalation to avoid first pass
tolerance (break at night) and withdrawal
interacts with PDE5 inhibitors(sildenafil = viagra)
uses: angina, CHF. MI
do not use with: patients on sildenafil/viagra, with hypotension, diastolic heart failure

22
Q

why cant someone using sildenafil/viagra use an organic nitrate?

A

sildenafil degrades cGMP

organic nitrates increase cGMP so it would just make the drug ineffective

23
Q

how do organic nitrates work?

A

release NO
activate guanylyl cyclase –> increase cGMP
phosphatase dephosphorylates myosin light chain and myosin/actin are uncoupled
=vasodilation!!

24
Q

difference between organic nitrates and ca ch blockers?

A

ON - just vasculature, mainly dilate veins, does not change contractility of heart
Cach - vasculature AND myocardium, mainly dilate arteries, lower heart contractility!

25
Q

How do organic nitrates avoid coronary steal?

A

they mostly affect the LARGE epicardial coronary vessels –> so they avoid the coronary steal when all vessels are dilated

26
Q

nitroglycerin vs isosorbide dinitrate and isosorbide 5 mononitrate

A

nitroglycerin has SHORT half life(2-8 min) and low bioavailability
ID - chewable, 2-3 hrs duration
I5M - 5 hrs, cervical ripener in delivery

27
Q

what drug can be used to ripen cervix in delivery?

A

isosorbide 5 mononitrate

28
Q

ca channel blockers

A

vasculature (mainly arteriodilation) AND myocardium
block Ltype Ca channels –> inhibit ca influx and relax arteries = decreased coronary resistance and increases BF
DECREASES contractility
DONT USE with heart failure patients
side effects: cardiac depression, AV block, bradycardia, CHF

29
Q

what anti-anginal type drugs decrease heart contractility?

A

ca channel blockers and B blockers

30
Q

what anti-anginal drug should you NOT use with heart failure patients

A

ca channel blockers!

31
Q

dihydropyridines vs non-dihydropyridines

A

types of ca channel blockes
dy- coronary and peripheral vasodilation BUT reflex increase in HR and contractility
non-dy- dilate BUT also decrease HR, contractility, recovery, and AV conduction

32
Q

what type of ca ch blocker can cause decreased AV conduction? two drugs that do it?

A

nondihydropyridine

verapamil and diltiazem

33
Q

verapamil

A

a phenylalkylamine

less potent than dihydropyridines but decreases HR, contratility, recovery, and AV conduction

34
Q

diltiazem

A

a benzothiazepine
nonspecific antagonist of sympathetic NS
inhibits AV conduction

35
Q

what do you treat supraventricular reentry tachy and atrial flutter/fib/tachy with? why?

A

verapamil and diltiazem

they decrease AV node conductivity

36
Q

nifedipine

A

dihydropyridine
relaxes smooth muscles at lower loses than cardiac cells
decreases arterial resistance and BP
doesnt affect AV node

reflex increase in CO

37
Q

what to treat subarachnoid hemorhage with?

A

nimodipine - high affinity for cerebral vessels!

reduces vasospasms

38
Q

b blocker mechanisms to reduce O2 demand

A

1) reduce HR (conduction velocity)
2) reduce contractility
3) reduce arterial BP

39
Q

where do B blockers work?

A

B1 - heart/renal

B2 - everywhere else (vessels, lungs, bladder, GI)

40
Q

side effects of B blockers?

A

erectile dysfunction and CNS effects (insomnia and depression)

41
Q

B blockers effect on BP - up and down!?

A

initially increase resistance/BP –> net effect is a combination that decreases BP (- inotropism lowers CO, renin inhibition, CNS)

42
Q

what drug category can cause erectile disfunction?

A

b blockers

43
Q

propanolol/sotalol

A

nonselective B inhibitor (B1 and B2)
treat HTN, angina, arrhythmias
NOT FOR VARIANT ANGINA OR asthma/COPD patients!

44
Q

why cant you use propanolol/sotalol for variant angina or patient with breathing issues?

A

B2 blocking causes 1) unapposed alpha 1 vasocontriction –> increased resistance, afterload, and O2 demand = less coronary flow
2) B2 blocking can cause bronchoconstriction

45
Q

two nonselective B blockers? contraindications?

A

propanolol, sotalol

variant angina/asthma and copd

46
Q

atenolol

A

B1 selective

can be used in patients with copd and asthma

47
Q

what to treat angina patients who have breathing issues with?

A

atenolol

B1 selective!

CPR 1st half (11 decks)

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