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Pharmacology > Antianginal Drugs > Flashcards

Antianginal Drugs Flashcards

0
Q

Coronary Artery Disease: Causes

A 
Atherosclerosis
Coronary artery vasospasm
   - Variant or prinxmetals angina
   - Serotonin, histamine, and endothelium-derived factors all implicated
Emboli
Congenital coronary artery abnormalities
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1
Q

Angina: Pathphysiology

A

Condition of intermittent, relative myocardial ischemia accompanied by pain in the chest
Inability of coronary arteries to supply sufficient oxygenated blood to heart muscle

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2
Q

Angina Risk factors

A 
Hyperlipemia
Elevated BP
Cigarette smoking
ECG abnormalities
Diabetes mellitus
Hyperthyroidism
Anxiety
Psychosocial problems
Caffeine 
Medications
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3
Q

Goal of Drug Therapy for Angina

A

Correcting inadequacy of myocardial oxygenation

Increasing delivery of oxygen to ischemic areas by dilation of coronary arteries

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4
Q

How do you correct oxygen inadequacy

A

Reduce HR, contractility, afterload and/or preload

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5
Q

Limitations of coronary vasodilators

A

Physical limits imposed by plaques
Vasculature in ischemic areas may already be maximally dilated
“Coronary steal”
- Blood diverted away from ischemic areas by dilating healthier vessels
Vasodilators still useful in treating angina precipitated by coronary spasm

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6
Q

Classification of Angina

A 
Stable angina (Type 1)
Vasospastic angina (Type 2)
Unstable angina (Type 3)
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7
Q

Signs of Type 1 angina

A

Usually atherosclerosis without rupture of atheroma
No thrombosis
Exertion, cold, stress, emotion or eating increases myocardial demand
Responds positively to rest and/or nitroglycerin

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8
Q

Treatment of Stable angina

A

Decrease cardiac load (pre/after), increase blood flow

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9
Q

Type 2 symptoms

A

Caused by transient vasospasm of the coronary vessels
Usually associated with underlying atheromas without rupture of atheroma
No thrombosis
Occurs at rest, during REM sleep
Responds positively to nitroglycerin

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10
Q

Vasospastic angina treatment

A

Decrease vasospasm of coronary vessels

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11
Q

Type 3 symptoms

A

Caused by recurrent episodes of small platelet clots at the site of a ruptured atherosclerotic plaque
Can precipitate local vasospasm
Change in character, frequency, and duration
Requires vigorous therapy as it signals the imminent occurrence of a MI

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12
Q

Unstable angina treatment

A

Inhibit platelet aggregation and thrombus formation, decrease cardiac load, and vasodilate coronary arteries

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13
Q

Function of Organic Nitrates (Nitrovasodilators)

A

Reduction in preload
Decrease cardiac oxygen demand by dilating veins and decreasing venous return
Direct relaxation of smooth muscles, particularly vascular smooth muscle of veins
Produces a decrease in venous return
- Results in a decreased ventricular end-diastolic volume and decreased CO
- Decreased ventricular wall tension associated with decreased myocardial O2 requirement

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14
Q

Effect of NTG in Stable Angina

A

An alternative hypothesis proposed for nitroglycerin action suggests that these drugs produce specific redistribution of coronary blood flow by dilating intra-arterial anastomosis
- Total coronary blood flow and coronary vascular resistance remain fixed or decreased
Antianginal effect of nitrates is due to decreased oxygen demand associated decreased venous return and subsequent decrease in intracardiac volume-> decreased wall tension-> decreased cardiac work

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15
Q

Adverse effects of Organic Nitrates

A 
Orthostatic hypotension
Reflex tachycardia
   - Requires the heart does more work
Flushing
   - Especially in blush region
Dilation of retinal blood vessels
Headache
   - Dilation of cerebral blood vessels
Nausea, vomiting, vertigo
16
Q

Drug interactions of Organic Nitrates

A

Hypotensive drugs
- Intensifies effects; use caution with beta blockers, calcium channel blockers, diuretics, alcohol
Beta blockers, verapamil, and diltiazem
- Suppress nitroglycerin-induced tachycardia
Sildenafil (Viagra)
- Intensifies NTG vasodilation
- Inhibition of the enzyme that breaks down cyclic GMP
- cGMP

17
Q

Organic Nitrates: Tolerance and Cross-tolerance

A

Develops rapidly even in a single day
- Partly due to depletion of sulfhydryls in vascular smooth muscle
Use lowest effective dose therapy
Allow at least 8 hours of drug-free time
Reverse tolerance by withholding nitrates

18
Q

Rapid-acting (sublingual or transmucosal tablets or translingual spray)

A

Nitroglycerin

19
Q

Nitroglycerin (Sublingual tablets)

A

About as effective and more prolonged action
Transdermal patches and sustained release tablets for long duration effect for prophylaxis
Should be kept in a tinted glass, air tight jar
Intravenous infusion
- Emergency use
- For patients who failed to respond to other therapy
Monitor HR and BP continuously
For perioperative control of BP, controlled hypotension during surgery

20
Q

Amyl nitrate: State and use

A

Liquid in crushable ampules and vapor inhaled
Only used for cyanide intoxication
- Induces methemoglobinemia

21
Q

What is NTG used in?

A

Transdermal patches
topical ointments
Transmucosal tablets or sustained release tablets or capsules

22
Q

Calcium Channel blockers: Agents

A

Verapamil
Nifedipine
Diltiazem

23
Q

CCB: Use

A

Decrease myocardial work
Prinzmetal angina is characterized by spasms of coronary arteries
Patients may or may not respond to nitrates and beta-blockers may even be detrimental
CCB often best to relieve coronary spasm

24
Q

CCB: mechanism

A

Calcium influx blockade

Binds to “channels” responsible for normal activity are susceptible to blckade

25
Q

Beta-blockers: agents

A

Propranolol

26
Q

Propranolol: Action

A

Decrease myocardial workload
Decrease in CO
Reduce the effects of NE, EPI on cardiac rate and force of contraction
Increase in cardiac work that precipitates pain after stress, exercise or other stimulis alleviated by beta blockers
Decrease myocardial O2 requirement in response to catecholamines
No effect on coronary artery

27
Q

Method of action of NTG in Variant

A

Relaxes or prevents spasm in coronary arteries, thus increasing oxygen supply

28
Q

Variant Angina: Treatment

A

CCB especially useful in relaxing coronary vasospasm

BB not useful

29
Q

What three steps do you take in the treatment of vasospastic angina?

A

Calcium channel blocker or long-acting nitrate
Combine the two
CABG surgery

Pharmacology (13 decks)

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