Anti Anginal Drugs Flashcards

1
Q

When does most of coronary blood flow occur?

A

85% during diastole

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2
Q

What are the major regulators of coronary blood flow?

A

Local metabolites that cause vasodilation (such as adenosine)

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3
Q

In what situations would myocardial O2 demand be increased?

A

Exercise
Sympathetic stimulation
Tachyarrhythmias

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4
Q

In what situations would you have decreased coronary artery blood supply?

A

Systemic hypotension
Vasospasm
Thrombus/Embolus

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5
Q

What class of drugs is comprised of potent vasodilators used in angina?

A

Nitrates

first line therapy for stable angina

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6
Q

Nitrates

MOA

A

NO Donors functioning independently of endothelial cells.

Activation of guanylyl cyclase, more cGMP made, less MLCK activation, more smooth muscle relaxation

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7
Q

What are the physiological effects of nitrates?

A
Venodilation
Decreased venous return
Reduced LV Wall Tension
Reduced afterload
Direct coronary artery vasodilation
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8
Q

Clinical Uses of Nitrates

A

Angina Pectoris (Stable, Unstable, Prinzmetal)
HTN Emergencies
CHF
Prevent or reduce exercise-induced myocardial ischemia

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9
Q

Nitrates

Adverse Effects

A

Orthostatic hypotension
reflex tachycardia (baroreceptor)
Headache
Tolerance

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10
Q

Describe the role of Ca2+ in vascular smooth muscle EC coupling

A

Ca2+ enters cell, binds calmodulin, which will activate MLCK (through phosphorylation). That will eventually phosphorylate myosin light chain to cause muscle contraction

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11
Q

Ca2+ Channel Blockers are potent anti-arrhythmics. Why?

A

SA/AV node fibers use Ca2+ for their phase 0 depolarization and phase 4 depolarization

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12
Q

Ca2+ Channel Blockers

Clinical Uses

A
Angina Pectoris
HTN
Arrhythmias
Hypertrophic Cardiomyopathy
Migraines
Raynaud's phenom (vasospasm of peripheral vessels upon cold exposure)
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13
Q

Which Ca2+ Channel Blocker has the greatest vasodilatory effects?

A

Nifedipine

Has the most vascular smooth muscle selectivity

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14
Q

Which Ca2+ Channel Blocker has the best negative chronotropic and inotropic effects?

A

Verapamil

Diltiazem is a close second

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15
Q

Verapamil

Adverse Effects

A
Bradycardia
CHF
Heart Block
Hypotension
Constipation
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16
Q

Diltiazem

Adverse Effects

A

Bradycardia
CHF
Heart Block
Hypotension

17
Q

Nifedipine

Adverse Effects

A

Tachycardia
Peripheral edema
Hypotension

18
Q

What is the role of phospholamban? How is it inhibited?

A

Inhibits the SERCA channel on the SR. PKA phosphorylates it to reduce its inhibitory activity, thus increasing SERCA pump function.

19
Q

Beta Blockers

General MOA

A

Decrease inotropy
Decrease chronotropy
Decrease lusitropy
Decrease conduction

20
Q

Beta Blockers

Adverse Effects

A

Bronchospasm
Peripheral vasospasm
Exaggeration of cardiac therapeutic effects
Insomnia, depression, fatigue

21
Q

Beta Blockers

Contraindications

A
Acute CHF
Bradycardia
Heart Block
Severe peripheral vascular disease
DMT1
Bronchospasm (asthma)
22
Q

Ranolazine
Clinical Indications
MOA

A

Reduces angina frequency

Not clear on mechanism

23
Q

Ivabradine
Clinical Indications
MOA

A

If (Funny) current inhibitor

Anti-anginal drug in patients who cannot take beta blockers

24
Q

Nonpharmacological Rx of Angina

A
Exercise Training
Angioplasty
Atherectomy
Stents
Intra-Aortic Balloon Counterpulsation
Coronary Artery Bypass Graft