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Pharm Midterm 1 > Anti-Anginals > Flashcards

Anti-Anginals Flashcards

1
Q

What are the types of angina

A

Stable
Unstable
Variant (Prinzmetal)

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2
Q

What are the classes of angina

A

0-4

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3
Q

What is the only Tx rationale that works for Prinzmetal

A

Decrease O2 demand

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4
Q

What are the organic nitrates used for Angina

A

Isosorbide mononitrate
Isosorbide dinitrate
Nitroglycerin
Sodium nitroprusside

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5
Q

What beta blockers are used for Angina

A

Acebutolol
Atenolol
Metoprolol
Propranolol

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6
Q

What Ca channel blockers are used for Angina

A

Amlodipine
Fenoldipine
Verapamil
Diltiazem

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7
Q

What Na channel blocker is used for Angina

A

Ranolazine

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8
Q

Which antianginals mimic NO

A

Organic nitrates

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9
Q

Which cause a rapid reduction in myocardial O2 demand

A

Organic nitrates

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10
Q

Mechanism of organic nitrates

A

Activate guanylyl cyclase
SM relaxation
Decrease coronary vasoconstriction
Veinous dilation

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11
Q

Which is used as oral angina prophylaxis

A

Isosorbide mononitrate

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12
Q

What do you use for an ongoing angina attack

A

Isosorbide dinitrate

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13
Q

What is given sublingual as 1st line Tx for acute angina Sx

A

Nitroglycerin

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14
Q

What is given in unstable angina and HF

A

IV Nitroglycerine

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15
Q

What is used for angina in emergency

A

Sodium nitroprusside

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16
Q

Longer duration than Nitroglycerine

A

Isosorbide mononitrate

Isosorbide dinitrate

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17
Q

How is nitrate tolerance/desensitization overcome

A

Nitrate free interval (10-12hrs)

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18
Q

Nitrate contraindication

A

Pt on Sidenafil

Sidenafil inhibits PDE5 = too much cGMP

19
Q

Which nitrate can cause CN poisoning

A

Sodium nitroprusside

20
Q

Which beta blocker is not cardioselective

A

Propranolol

21
Q

Which beta blockers are beta 1 cardioselective

A

Metoprolol

Atenolol

22
Q

Main mechanism of beta blockers in angina

A

Decrease O2 load
Decrease freq/severity of attacks
Decrease HR, contractility

23
Q

Who do you give beta blockers for angina

A

Stable angina with LV dysfunction

24
Q

What happens if you rapidly remove beta blocker

A

Rebound HTN

25
Q

Contraindications for beta blockers in angina

A

Prinzmetal
Asthma/COPD
Diabetes, PVD
Severe bradycardia

26
Q

DOC for variant angina

A

Ca channel blockers

27
Q

When do you use ca channel blockers

A

Beta blockers don’t work, or contraindicated

28
Q

How do Ca channel blockers work

A

Coronary, peripheral vasodilation

Reduce contractility

29
Q

Which Ca channel blockers have minimal effect on conduction or HR

A

Amlodipine
Felodipine
Block Ca entry, decrease BP

30
Q

Which Ca channel blockers slow AV conduction directly

A

Verapamil

Diltiazem (less HR decrease)

31
Q

Main AE of Ca channel blockers

A

Constipation

32
Q

Contraindication for Diltiazem/Verapamil

A

Pre-existing depressed cardiac function

AV conduction abnormality

33
Q

Caution for Verapamil in patients on what

A

Digoxin

34
Q

What does the Na/Ca exchanger do in ischemia

A

Reverses direction

35
Q

What does Ranolazine do

A

Block the Na/Ca exchanger, indirectly lowering Ca levels

36
Q

How does Ranolazine treat angina

A

Decrease contractility
Decrease O2 demand
Modify FA oxidation

37
Q

What is Ranolazine prophylactic for

A

Angina when all other failed

38
Q

What metabolizes Ranolazine

A

3A4

39
Q

AE for Ranolazine

A

QT prolongation
Nausea, constipation
Dizziness

40
Q

Acute attack Tx for Stable/Unstable

A

Nitroglycerin

41
Q

Maintenance therapy for Stable/Unstable

A 
Long acting nitrates
Beta Blockers (Ca channel blockers if ineffective)
42
Q

Last ditch therapy for Stable/Unstable

A

Ranolazine

43
Q

Nitrate half lives shortest to longest

A

Sodium Nitroprusside
Nitroglycerine
Isosorbide dinitrate
Isosorbide mononitrate

44
Q

Tx for Prinzmetal Sx only

A

Nitroglycerin

Ca channel blockers (any)

Pharm Midterm 1 (36 decks)

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