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Pharm2: Module 2 > Antianginal agents > Flashcards

Antianginal agents Flashcards

1
Q

what is angina pectoris

A

recurrent chest pain or discomfort when part/some of the heart does not get enough oxygen

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2
Q

where is angina pectoris located

A

Retrosternal or slightly to the left of Midline
occasionally limited to extra thoracic sites

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3
Q

where does angina pectoris radiate

A

neck, throat (‘choking’ sensation)
Jaw, teeth (‘toothache’)
left shoulder, arm (ulnar distribution)
epigastrium (heart burn)

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4
Q

a patient presents with new onset, increase in intensity, frequency or duration occurs at rest - what are you thinking

A

unstable angina or evolving acute MI

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5
Q

what is the quality and quantity (description) of angina

A

tightness, pressure, squeezing, heaviness, burning, aching, fullness
“heavy weight” or “band across my chest”
dull and deep

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6
Q

what is angina aggravated by

A

physical exertion
emotional stress
after eating heavy meals
environment
lying down

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7
Q

what is angina relieved by

A

rest
activity cessation
withdrawal of stressor
pharmacotherapy

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8
Q

What are alternative names for effort angina

A

“classic angina”
“Stable angina”

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9
Q

what is the presentation of effort angina

A

short lasting; heavy, burning, squeezing in chest
does not change - pattern stays the same
most common form

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10
Q

what is the cause of effort angina

A

inadequate blood flow in the presence of CAD
reduction of perfusion due to FIXED obstruction of coronary artery

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11
Q

what are the treatment options for effort angina

A

nitrates or rest

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12
Q

what are other names for vasospastic angina

A

variant angina
prinzmetal angina

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13
Q

what causes vasospastic angina

A

coronary artery spasm causing decreased blood flow of the heart muscle - uncommon patter, episodic

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14
Q

what are precipitators for vasospastic angina

A

occurs at rest, unrelated to physical activity, heart rate or blood pressure

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15
Q

what are the treatment options for vasospastic angina

A

coronary vasodilators (nitrates and CCB)

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16
Q

when does unstable angina occur

A

progressively less effort causes more increased frequency, duration and intensity of pain

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17
Q

what is the treatment for unstable angina

A

HOSPITAL ADMISSION, aggressive therapy to prevent progression to MI

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18
Q

what usually results from rupture of atherosclerotic plaque and partial/complete thrombosis of coronary artery

A

Acute Coronary Syndrome (ACS) - EMERGENCY
NSTEMI, STEMI, Unstable Angina

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19
Q

what causes an increase in biomarkers

A

necrosis of CV tissue

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20
Q

what are major determinants of cardiac oxygen consuption

A

wall stress/tension - IVP, ventricular radius (Volume), thickness
Heart rate
contractility

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21
Q

what is preload

A

initial stretchign of cardiac muscle cells proior to contraction
change affect ventricular stroke

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22
Q

what is afterload

A

force or load against which the heart contracts to eject the blood

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23
Q

what is contractility

A

strength of cardiac muscle

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24
Q

what changes and affects the force of contraction

A

change in preload

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25
Q

what is the ventricular wall tension based on

A

thickness of the ventricular myocardium

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26
Q

what is the most important factor affecting myocardial oxygen demand

A

Heart rate

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27
Q

what increases heart oxygen consuption

A

increased heart rate

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28
Q

what is influenced by a variety of forces including calcium concentration

A

contractility

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29
Q

what is needed with more powerful contractions

A

more energy is needed

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30
Q

what are chronotropic drugs

A

changes in heart rate
both positive and negative

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31
Q

what kind of drugs decrease heart rate

A

negative heart rate

32
Q

what are inotropic drugs

A

alter the strength of the contraction of the heart
Positive and negative

33
Q

what strengthens the force of the heartbeat

A

positive inotropic drugs

34
Q

what are anginal relief medication types

A

BB
CCB
nitrates
sodium channel-blocking drug (ranolazine)
interventional therapy

35
Q

what are selective beta 1 blocker medicatiosn

A

Metoprolol
Atenolol

36
Q

what are calcium channel blockers

A

amlodipine
felodipine
nefidipine
diltizaem
verapamil

37
Q

what are organic nitrates

A

isosorbide mononitrate
nitroglycerin
isosorbide dinitrates

38
Q

what are b1 selective BB effective for

A

effort and unstable angina

39
Q

what medicatiosn decrease oxygen demands on the myocardium which decreases the HR, contractility, CO and blood pressure

A

B1-adrenergic Beta Blockers

40
Q

what are the contraindications for BB

A

severe bronchospasm - asthma
vasospastic angina (ineffective and can make it worse)
Bradycardia
pindolol should be avoided in pts with prior MI/angina due to sympathominmetic effects

41
Q

what are the side effects of BB medications

A

cold hands/feet
fatigue
nausea, weakness and dizziness
dry mouth, skin and eyes
weight gain

42
Q

what is the recommended initial antianginal therapy

A

beta - adrenergic blockers

43
Q

what are the effects of BB with patients with chronic renal disease

A

less effective - CCB/nitrates more effective

44
Q

what can occur with abrupt discontinuation of BB

A

rebound angina, MI, HTN

45
Q

what is metoprolol

A

cardioselective
causes less bronchial constriction than propranolol
extensively metabolized
short half life (4-6 hrs)

46
Q

what is atenolol

A

cardioselective
not extensively metabolized and excreted primarily in urine
half life 6 hours
less effective than metoprolol in preventing complications of HTN

47
Q

what are the CCB medications

A

effective in effort and vasospastic angina
amlodipine
felodeipine
verapamil
nifedipine
diltiazem

48
Q

what is the MOA for CCB

A

inhibits enterence of calcium into cardiac and smooth muscle cells of the coronary and systemic arterial beds
dilates arterioles, causes decrease in smooth muscle tone and vascular resistance

49
Q

what are contraindications for CCB

A

pre-existing conduction disorder
symptomatic hypotension
ACS
grapefruit juice

50
Q

what are the side effects of CCB

A

lightheadedness
low BP
slower HR
constipation
swelling in feet and ankles

51
Q

what are the non-dihyrophyridine CCBs

A

Verapamil and diltiazam

52
Q

what are the dihydrophyridine CCB

A

amlodipine
nifedipine
felodipine

53
Q

what is amlodipine

A

dihydropyridine
greater effect on smooth muscle in peripheral vasculature
minimal effect on cardiac conduction
second generation dihydropyridine derivative
not recommended in pts with HF

54
Q

what is felodipine

A

second generation dihydropyridine derivative
not recommended in pts with HF

55
Q

what is nifedipine

A

dihydropyridines
treat vasospastic angina
can increase HR; risk for tachycardia and increase O2 demand
peripheral dilatory effects can decrease coronary perfusion

56
Q

what are the side effects of Nefedipine

A

dizziness, lightheadedness, LE edema

57
Q

what is diltiazem

A

non-dihydropyridine
immediate in its actions
monitor closely when using with other meds for angina as effects are additive
monitor for bradyarrhythmias and heart block

58
Q

what is verapamil

A

non-dihydropyridine
mainly affects the myocardium
greater negative inotropic effects than amlodipine
monitor for bradyarrhythmias and heart block

59
Q

what patients is verapamil not recommended for

A

pts with sick sinus syndrome, AV nodal disease or heart failure

60
Q

what are the organic nitrates

A

isosorbide mononitrates
nitroglycerin
isosorbide dinitrates
effects in effort, vasospastic and unstable angina

61
Q

what is the MOA for nitrates

A

venous dilation - reduces preload and myocardial wall tension, decrease oxygen requirements (demand)
reduction of arteriolar resistance - reduces afterload and decreases oxygen demand

62
Q

what are the contraindications with nitrates

A

coadministration of PDE-5 inhibitors (viagra)
severe anemia
increased ICP
circulatory failure and shock

63
Q

what are the SE of nitrates

A

HA
dizziness
lightheadedness
nausea
flushing
low BP

64
Q

what is nitroglycerine

A

considered prototype drug
administered sublingually usually
treatment of anginal attacks
fast onset of action
stays in the body for short duration and broken down by liver

65
Q

what is isosorbide mononitrate

A

taken daily
for prevention of angina
onset 60-120 min
duration 5-12 hours

66
Q

what is isosorbide dinitrate

A

sublingual tablet or immediate release
prophylaxis for acute angina
sublingual: onset 2-5min; duration 1-2 hours
immediate release: onset 20-40 min; duration 4-6 hours

67
Q

what is the sodium channel blockers

A

ranolazine

68
Q

what is ranolazine

A

inhibits the late phase of sodium current improving oxygen supply and demand
improves diastolic function
antianginal and anti-arrhythmic properties
used when others hav failed

69
Q

what are the risks with ranolazine

A

risk of drug interactions and can prolong QT interval

70
Q

when are combination therapy used

A

used if there is intolerance or angina symptoms persist despite the optimal dosage of a single drug
treatment tailored to how frequent angina episodes/attacks occur within a given week
aimed at alleviating symptoms and supporting the heart

71
Q

what is the benefit of combining nitrates with BB or CCB

A

decrease the degree of cardiac ischemia and improves exercise intolerance

72
Q

what medications when used with BB have additive effects on SA and AV nodes

A

diltiazem or verapamil (CCB)

73
Q

why is the combination of nitrate and sildenafil potentially dangeous

A

both cause vasodilation
this can lead to lowering of BP and blood flow that can precipitate a heart attack

74
Q

what considerations are made to determine medical therapy and surgical therapy for angina

A

patient dependent
- testing results
-pt age
-symptom severity
-stage/level of heart disease
-peripheral artery disease

75
Q

what is interventional therapy used for

A

primarily to improve symptoms when optimal medication therapy has failed
beneficial when coronary arteries are significantly narrowed, there are many coronary arteries that are narrowed and when left main coronary artery is narrowed

76
Q

has standing been shown to prolong life compared to medication therapy

A

no

Pharm2: Module 2 (4 decks)

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