Anti-Anginals Flashcards
What are the types of angina
Stable
Unstable
Variant (Prinzmetal)
What are the classes of angina
0-4
What is the only Tx rationale that works for Prinzmetal
Decrease O2 demand
What are the organic nitrates used for Angina
Isosorbide mononitrate
Isosorbide dinitrate
Nitroglycerin
Sodium nitroprusside
What beta blockers are used for Angina
Acebutolol
Atenolol
Metoprolol
Propranolol
What Ca channel blockers are used for Angina
Amlodipine
Fenoldipine
Verapamil
Diltiazem
What Na channel blocker is used for Angina
Ranolazine
Which antianginals mimic NO
Organic nitrates
Which cause a rapid reduction in myocardial O2 demand
Organic nitrates
Mechanism of organic nitrates
Activate guanylyl cyclase
SM relaxation
Decrease coronary vasoconstriction
Veinous dilation
Which is used as oral angina prophylaxis
Isosorbide mononitrate
What do you use for an ongoing angina attack
Isosorbide dinitrate
What is given sublingual as 1st line Tx for acute angina Sx
Nitroglycerin
What is given in unstable angina and HF
IV Nitroglycerine
What is used for angina in emergency
Sodium nitroprusside
Longer duration than Nitroglycerine
Isosorbide mononitrate
Isosorbide dinitrate
How is nitrate tolerance/desensitization overcome
Nitrate free interval (10-12hrs)
Nitrate contraindication
Pt on Sidenafil
Sidenafil inhibits PDE5 = too much cGMP
Which nitrate can cause CN poisoning
Sodium nitroprusside
Which beta blocker is not cardioselective
Propranolol
Which beta blockers are beta 1 cardioselective
Metoprolol
Atenolol
Main mechanism of beta blockers in angina
Decrease O2 load
Decrease freq/severity of attacks
Decrease HR, contractility
Who do you give beta blockers for angina
Stable angina with LV dysfunction
What happens if you rapidly remove beta blocker
Rebound HTN
Contraindications for beta blockers in angina
Prinzmetal
Asthma/COPD
Diabetes, PVD
Severe bradycardia
DOC for variant angina
Ca channel blockers
When do you use ca channel blockers
Beta blockers don’t work, or contraindicated
How do Ca channel blockers work
Coronary, peripheral vasodilation
Reduce contractility
Which Ca channel blockers have minimal effect on conduction or HR
Amlodipine
Felodipine
Block Ca entry, decrease BP
Which Ca channel blockers slow AV conduction directly
Verapamil
Diltiazem (less HR decrease)
Main AE of Ca channel blockers
Constipation
Contraindication for Diltiazem/Verapamil
Pre-existing depressed cardiac function
AV conduction abnormality
Caution for Verapamil in patients on what
Digoxin
What does the Na/Ca exchanger do in ischemia
Reverses direction
What does Ranolazine do
Block the Na/Ca exchanger, indirectly lowering Ca levels
How does Ranolazine treat angina
Decrease contractility
Decrease O2 demand
Modify FA oxidation
What is Ranolazine prophylactic for
Angina when all other failed
What metabolizes Ranolazine
3A4
AE for Ranolazine
QT prolongation
Nausea, constipation
Dizziness
Acute attack Tx for Stable/Unstable
Nitroglycerin
Maintenance therapy for Stable/Unstable
Long acting nitrates Beta Blockers (Ca channel blockers if ineffective)
Last ditch therapy for Stable/Unstable
Ranolazine
Nitrate half lives shortest to longest
Sodium Nitroprusside
Nitroglycerine
Isosorbide dinitrate
Isosorbide mononitrate
Tx for Prinzmetal Sx only
Nitroglycerin
Ca channel blockers (any)
