Antianginal Drugs

Question 1

Nitroglycerin: Class

Answer 1

Nitrate

Question 2

Nitroglycerin: Brand name

Answer 2

NitroStat

Question 3

Nitroglycerin: Mechanism of Action

Answer 3

Reacts directly with nitrate receptor on SM cell to release NO -> GC -> cGMP -> relax smooth muscle cells -> vaso/venodilation
High first pass effect, so not good for oral

Question 4

Nitroglycerin: Use

Answer 4

Taken sublingually (or transderm, IV) prn to relieve typical or variant angina

Question 5

Nitroglycerin: Adverse Effects

Answer 5

Tolerance can develop quickly
Excessive hypotension, throbbing headache, dizziness, flushing
Avoid Viagra (-> hypotension)

Question 6

Differentiate atenolol, metoprolol, and propranolol.

Answer 6

Atenolol: long acting B1 blocker
Metoprolol: short acting B1 blcoker
Propranolol: nonselective B blocker

Question 7

Atenolol: mechanism of action

Answer 7

Selectively block B1 receptors -> Decrease HR, contractility, CO, BP (afterload), and wall tension -> reduce oxygen demand
Increase diastolic perfusion by increasing time for diastole

Question 8

Beta blockers: contraindications, caution

Answer 8

Should NOT abruptly withdraw beta-blocker; can -> increased angina, acute MI

Should NOT be used for vasospastic angina

Question 9

Verapamil: class, other drug in class

Answer 9

Class: calcium entry blocker
Other: Diltiazem

Question 10

Verapamil: mechanism of action

Answer 10

Block calcium channels -> Decrease HR, contractility, CO, BP (afterload), and wall tension -> reduce oxygen demand
Increase diastolic perfusion by increasing time for diastole

Question 11

Verapamil: Use

Answer 11

Acts directly on the heart and produces peripheral vasodilation to relieve both typical angina and variant angina

Question 12

Aspirin: class, brand name

Answer 12

Antiplatelet agent

Bayer Aspirin

Question 13

Aspirin: mechanism of action

Answer 13

Irreversibly blocks COX-1 in platelets, inhibiting formation of TBXA2 (vasoconstrictor, platelet aggregator)

Question 14

Aspirin: use

Answer 14

Taken po for antiplatelet effects to prevent MI

Question 15

Aspirin: adverse effects, contraindications

Answer 15

Ulceration of GI tract, bleeding disorders, tinnitus

Avoid in pts with nasal polyps and asthma

Question 16

Clopidogrel: class, brand name

Answer 16

Antiplatelet agent

Plavix

Question 17

Clopidogrel: mechanism of action

Answer 17

Blocks ADP receptors irreversibly to prevent aggregation mediated by ADP released by activated platelets

Question 18

Clopidogrel: use

Answer 18

Taken po (in conjunction with aspirin) for primary or secondary prevention of TIA, stroke, angina, MI, post-angioplasty, ACS

Question 19

Clopidogrel: adverse effects

Answer 19

Hemorrhage at any site, extensive skin bruising and discoloration

Question 20

Abciximab: class, brand name

Answer 20

Platelet Gp IIb/IIa receptor blockers

ReoPro

Question 21

Abciximab: mechanism of action

Answer 21

Monoclonal antibody – inhibits GP IIb/IIIa receptor to prevent binding of fibrinogen, vWF, others to activated platelets
Short acting

Question 22

Abciximab: use

Answer 22

Used IV prior to PCI to prevent ischemic complications

Question 23

Abciximab: adverse effects

Answer 23

Bleeding
Contraindicated with aneurysm, AV malformation, coagulopathy, intracranial mass, stroke, surgery, low platelets, trauma, vasculitis

Question 24

(Brief) pathophysiology of angina

Answer 24

Myocardial oxygen demand outstrips oxygen supply

Question 25

Why are beta blockers contraindicated in treatment of variant angina?

Answer 25

Spasm likely related to surge of NE

Beta blockers compete with NE at beta receptors, make more available to bind to alpha1 receptors -> INCREASE spasm

Question 26

Given the pathophys of unstable angina or ACS, what drug action is essential to treat these conditions?

Answer 26

Suppression of platelet adhesion and aggregation!