Anti-Anginals and ED Drugs

Question 1

Classes of drugs used for angina

Answer 1

Organic nitrates
Calcium channel blockers
Beta blockers

Question 2

Main mechanism/goal of anti-anginal drugs

Answer 2

Reduce myocardial oxygen demand

Question 3

Factors that determine myocardial oxygen demand

Answer 3

Heart rate
Contractility
Ventricular wall stress (preload and afterload)

Question 4

Ways to reduce myocardial oxygen demand

Answer 4

Reduce preload or afterload
Reduce heart rate and contractility
Shift cardiac energy metabolism from oxidation of fatty acids to use of glucose (anaerobic metabolism)

Question 5

Factors that determine myocardial oxygen supply

Answer 5

Arteriolar dilation of coronary blood flow
Duration of diastole

Question 6

Ways to increase myocardial oxygen supply

Answer 6

Reduce heart rate
Dilate coronary arteries

Question 7

Prototype organic nitrate drug

Answer 7

Nitroglycerin

Question 8

Nitroglycerin MOA

Answer 8

Prodrug that releases NO when metabolized by ALDH-2

Question 9

Effect of nitroglycerin on heart

Answer 9

Dilates veins to decrease venous return and decrease preload to reduce oxygen demand
Modest dilation of large epicardial arteries to increase blood flow to regions of ischemia

Question 10

When is nitroglycerin used?

Answer 10

Prophylaxis and termination of acute a final attacks
Improves exercise tolerance
No survival benefit or prevention of MI

Question 11

Patient population that may not be able to metabolize nitroglycerin well due to ALDH-2 polymorphism

Answer 11

Patients of Asian origin

Question 12

Fast acting route of administration of nitroglycerin

Answer 12

Sublingual (1-2 minutes, lasts less than 1 hr)

Question 13

Tolerance to organic nitrates is more common with what route of administration

Answer 13

Oral and transdermal

Question 14

How to minimize nitroglycerin tolerance

Answer 14

Eccentric dosing (nitrate-free intervals of 10-12 hours)

Question 15

Adverse effects of nitroglycerin

Answer 15

Headaches
Facial flushing
Orthostatic hypotension
Reflex tachycardia

Question 16

Nitroglycerin drug interactions

Answer 16

Vasodilators
Alcoho;

Question 17

Two subclasses of calcium channel blockers

Answer 17

Dihydropyridines
Heart-rate lowering

Question 18

Dihydropyridine drug

Answer 18

Nifedipine

Question 19

Heart-rate lowering calcium channel blocker drug

Answer 19

Verapamil

Question 20

MOA of calcium channel blockers

Answer 20

Block intake of Ca2+ through voltage gated L-type calcium channels by binding to sites on the alpha 1 subunit
Vasodilators of peripheral and coronary arteries to decrease afterload and oxygen demand

Question 21

When are calcium channel blockers used for angina?

Answer 21

Prophylaxis

Question 22

Nifedipine acts mostly on what kind of tissue?

Answer 22

Vascular smooth muscle

Question 23

Verapamil acts mostly on which tissues?

Answer 23

SA and AV nodes

Question 24

Nifedipine has many drug interactions because it is metabolized by CYP___

Answer 24

CYP3A4

Question 25

Verapamil contraindications

Answer 25

Sick sinus syndrome AV nodal block

Question 26

clinical uses of calcium channel blockers

Answer 26

Angina Hypertension Arrhythmias

Question 27

Adverse effects of calcium channel blockers

Answer 27

Bradycardia in HRLs Reflex tachycardia, headache, and flushing in DHPs GERD

Question 28

Beta-1 selective blocker drug

Answer 28

Metoprolol

Question 29

Metoprolol MOA

Answer 29

Decrease HR, contractile force, and BP to decrease myocardial oxygen demand And increase oxygen supply

Question 30

Goal resting HR with B-blocker

Answer 30

55bpm

Question 31

Goal exercise BP with B-blocker

Answer 31

110-120 bpm

Question 32

Angina drug that reduces mortality

Answer 32

B-blockers

Question 33

What angina drug may worsen variant angina?

Answer 33

B-blockers

Question 34

Adverse effects of B-blockers

Answer 34

MI if sudden withdrawal Exercise intolerance Bronchoconstriction Sexual dysfunction

Question 35

Drug combination of anti-anginal drugs to avoid prescribing together

Answer 35

Beta blockers with HRL calcium channel blockers

Question 36

Drug class used for erectile dysfunction

Answer 36

Phosphodiesterase type 5 (PDE5) inhibitors

Question 37

PDE5 inhibitor drug

Answer 37

Sildenafil

Question 38

MOA of sildenafil

Answer 38

Selective inhibitor of PDE5 in corpora cavernosa that prolongs activity of endogenous cGMP to relax smooth muscle and increase blood flow

Question 39

When should sildenafil be taken?

Answer 39

1 hour before sexual activity

Question 40

Clinical uses of sildenafil

Answer 40

Erectile dysfunction Pulmonary hypertension

Question 41

Adverse effects of sildenafil

Answer 41

Headache and flushing Abnormal vision Dyspepsia Sudden hearing loss Priapism

Question 42

Drug interactions with sildenafil

Answer 42

Organic nitrates Alpha blockers