Anti-anginal Drugs

Question 1

Nitrate

MOA

Answer 1

1. Decreased venous return
   - dilates venous capacitance vessels
2. Reduces LV wall tension
   - LaPlace’s Law
3. Reduced Afterload
4. Direct coronary artery vasodilation
   - increased subendocardial perfusion

Question 2

Most commonly used organic nitrates for angina?

Answer 2

1. Nitroglycerin
   - sublingual
   - buccal spray
   - patch
   - ointment
2. Isosorbide mon/dinitrate
   - sublingual
   - chew
   - oral

Question 3

Nitrate Side effects

Answer 3

• orthostatic hypotension
• reflex tach
• headache
• nitrate tolerance

Question 4

Which calcium channel blocker has the most negative inotropic and chronotropic effects?

Answer 4

Verapamil>Diltiazem»Nifedipine

Question 5

Which calcium channel blocker has the greatest vasodilatory effects?

Answer 5

Nifedipine>Verapamil>Diltiazem

Question 6

What are side effects for verapamil and diltiazem?

Answer 6

1. Bradycardia
2. Congestive Heart Failure
3. Heart block
4. Hypotension

Question 7

What are the side effects of nifedipine?

Answer 7

1. Reflex Tachycardia
2. Peripheral Edema
3. Hypotension

Question 8

Beta Receptor Blockers block Beta1’s normal job of activating cAMP, what does cAMP do?

Answer 8

1. Increases opening of L-type Ca channels
   - Inotropy
2. Increased Reuptake of Ca into SR stores
   - Inotropy and Lusitropy
3. Increased Pacemaker current
   - chronotropy
4. Increased rate of conduction
   - dromotropy
5. inhibits phosphodiesterase

Question 9

What beta blockers are eliminated by the liver?

Answer 9

propranolol
carvedilol
metoprolol

PCM

Question 10

What beta blockers are eliminated by the kidney?

Answer 10

Atenolol
Nadolol
Sotalol

NAS

Question 11

What are the beta blockers that are non selective with ISA?

Answer 11

labetalol

pindolol

Question 12

What are the beta blockers that are cardioselective with ISA?

Answer 12

Acebutolol

Question 13

What are beta blockers used for clinically?

Answer 13

1. angina pectoris
2. hypertension
3. arrhythmias
4. dissecting aortic aneurysm
5. mitral valve prolapse
6. post MI prophylaxis
7. Hyperthyroidism
8. Migraine

Question 14

What are calcium channel blockers used for?

Answer 14

1. Angina pectoris
2. hypertension
3. arrhythmias
4. hypertrophic cardiomyopathy
5. Migrane
6. Raynaud’s phenomenon

Question 15

What are nitrates used for?

Answer 15

1. Angina Pectoris X3
2. Hypertensive Emergencies
3. Congestive Heart Failure

Question 16

What are the side effects of beta blockers?

Answer 16

1. bronchospasm
2. peripheral vasospasm
3. exaggeration of cardiac therapeutic effects
4. CNS(insomnia, depression, fatigue)

Question 17

What are contraindications of beta blockers?

Answer 17

1. Acute Congestive Heart Failure*
2. Marked brady
3. Advanced AV blcok
4. Severe peripheral vascular disease
5. insulin dependent diabetes mellitus
6. sexual impotence
7. bronchospasm

Question 18

Ranolazine MOA

Answer 18

inhibits fatty acid beta oxidation in myocyte mitochondria

Question 19

Ranolazine Indication

Answer 19

Chronic stable angina unresponsive to other agents

-now approved for exercise induced angina

Question 20

Ranolazine
Adverse Effects
Contraindications

Answer 20

Prolongs QT intervals

1. Long QT syndrome
2. Other drugs that prolong QT syndrome

Question 21

Ivabradine MOA

Answer 21

Blocks If current in SA nodal fibers

Question 22

Ivabradine Indication

Answer 22

chronic stable angina

-prevents exercise induced myocardial ischemia

Question 23

Ivabradine
Adverse Effects
Contraindications

Answer 23

Adverse Effects

1. Bradycardia
2. Heart Block
3. Luminous phenomenon

Contraindication

1. Sick Sinus Syndrome
2. Use with calcium channel blockers verapamil or diltiazem

Question 24

What are some nonpharmacological Rx of angina pectoris?

Answer 24

1. Exercise Training
2. Angioplasty
3. Atherectomy
4. Stents
5. Intra-Aortic Balloo nCounterpulsation -raising diastolic perfusion
6. Coronary artery bipass surgery (CABG)