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► Med - Pharmacology > Anti-Anginal Drugs > Flashcards

Anti-Anginal Drugs Flashcards

1
Q

How are oxygen demand and supply matched up to each other?

A

Through control of the coronary blood flow - NOT because of increased O2 extraction

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2
Q

When does coronary blood flow occur?

A

Most of it occurs during diastole

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3
Q

What are factors that contribute to myocardial O2 demand?

A

Heart Rate
Wall Tension
Contractility

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4
Q

What are the factors that contribute to myocardial O2 supply?

A

Diastolic Perfusion Pressure
Coronary Resistance
O2 Carrying Capacity

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5
Q

When does myocardial ischemia occur?

A

When myocardial demand surpasses supply

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6
Q

What is the most common cause of myocardial ischemia?

A

Atherosclerotic Coronary Artery Disease - often with manifestation of Angina Pectoris

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7
Q

How does severe aortic stenosis cause myocardial ischemia?

A

It causes high wall tension that can cause ischemia

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8
Q

What is the cause of Prinzmetal’s Angina?

A

Acute Coronary Vasospasm

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9
Q

What are the actions of nitrate drugs?

A

Vasodilation

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10
Q

Is the relaxation action of NO endothelium dependent?

A

No. Relaxation Is ENDOTHELIUM-INDEPENDENT.

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11
Q

Where do most of the actions of nitrates occur?

A

Systemic circulation - major venodilatory effects

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12
Q

What are the effects of nitrates?

A
  • Decreased venous return
  • Reduced LV wall tension
  • Reduced after load
  • Direct coronary artery vasodilation
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13
Q

Nitrate Indications

A

Angina Pectoris
Hypertensive Emergencies
Congestive Heart Failure

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14
Q

What are the 2 major nitrates?

A

Nitroglycerin

Isosorbide Mono/Dinitrate

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15
Q

What is the ROA of nitroglycerin that is often used?

A

Sublingual

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16
Q

What is the ROA of isosorbide mono/dinitrate that is often used?

A

Oral

17
Q

What are that main reasons for use of nitrates in exertion angina?

A
  • Terminate myocardial ischemia

- Prevent exercise induced myocardial ischemia

18
Q

Nitrate SE

A
  • Orthostatic hypotension
  • Reflex tachycardia
  • Headache
  • Nitrate tolerance
19
Q

What are Ca channel blockers anti-arrhythmic drugs?

A

L-type Ca channels regulate cardiac pacemaker activity

20
Q

Ca Channel Blocker Indications

A
  • Angina Pectoris
  • Hypertension
  • Arrhythmias
  • Hypertrophic Cardiomyopathy
  • Raynaud’s Phenomenon
21
Q

What are the 4 classes of CCBs?

A
  • DIHYDROPYRIDINES
  • VERAPAMIL
  • DILTIAZEM
  • BEPRIDIL
22
Q

What are examples of dihydropyridines?

A

– Nifedipine
– Nicardipine
– Amlodipine

23
Q

Rank the CCB-DHP drugs in order of negative inotropic and chronotropic effects?

A

– Verapamil>Diltiazem»Nifedipine

24
Q

Verapamil and Diltiazem SE

A

– Bradycardia
– Congestive Heart Failure
– Heart Block
– Hypotension

25
Q

Nifedipine SE

A

– Reflex Tachycardia (due to arterial vasodilation)
– Peripheral Edema
– Hypotension

26
Q

What are the actions of cAMP (triggered by beta receptors) in the heart?

A 
• Increased Opening of L-type Ca channels 
– Inotropy
• Increased Reuptake of Ca into SR stores 
–Inotropy & Lusitropy
• Increased Pacemaker Current 
– Chronotropy
• Increased Rate of Conduction 
– Dromotropy
27
Q

What is the main effect of beta blockers on the ischemic heart?

A

Decreases the O2 demand of the heart

28
Q

Beta Blocker Indications

A
  • AnginaPectoris
  • Hypertension
  • Arrhythmias
  • Dissecting Aortic Aneurysm
  • Hyperthyroidism
29
Q

What are the beta blockers eliminated by the liver?

A

Propranolol
Carvedilol
Metoprolol

30
Q

What are the beta blockers eliminated by the kidney?

A

Atenolol
Nadolol
Sotalol

31
Q

Ranolazine Actions

A

Ranolazine partially inhibits fatty acid oxidation, allowing the heart to use more glucose as a fuel by relieving the inhibition on pyruvate dehydrogenase.

32
Q

Ivabradine MOA

A

IF current inhibitor (funny current) which inhibits pacemaker activity and slows the heart rate at rest and during exercise.

33
Q

Ivabradine Indications

A

Angina

34
Q

Ivabradine SE

A

Luminous Phenomena

35
Q

What is the training effect?

A

HR and BP are lower at rest after prolonged exercise training

36
Q

What can be done to minimize nitrate tolerance?

A

Have nitrate-free intervals

37
Q

What drugs are useful in treating variant angina?

A

Nitrates and CCBs

38
Q

What are the mechanisms by which organic nitrates decrease the severity of myocardial ischemia?

A
  • Vasodilation of coronary arteries

- Venodilation will reduce venous return

39
Q

How can a beta-blocker increase blood flow to an area of ventricular muscle supplied by a stenotic coronary artery?

A

Decrease in heart rate increases myocardial O2 delivery - increased diastolic perfusion time, decreased vascular compression.

► Med - Pharmacology (74 decks)

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