Antianginal Drugs

Question 1

What causes angina?

Answer 1

A lack of blood flow to the heart itself. Angina is heart pain

Question 2

What is the main difference between Stable and Unstable Angina?

Answer 2

Stable angina occurs with exercise or excitement, and unstable occurs without activity

Question 3

Which type of angina is most common in women?

Answer 3

Microvascular angina

Spasms in smallest coronary arteries, pain lasting >10 min to 30 min

Question 4

Where does Variant angina occur?

Answer 4

Coronary artery vasospasm

Question 5

What are 4 categories of drugs that can treat Anginas?

Answer 5

1. Nitrates/nitrites
2. Beta-blockers
3. Calcium channel blockers (CCBs)
4. Ranolazine

Question 6

What are the 2 main systemic functions of Organic Nitrates?

Answer 6

1. Dilates coronary arteries
   - Useful in variant angina
2. Reduced cardiac preload (relax veins) and afterload (relaxed systemic arteries)
   * Overall causes vasodilation

Question 7

What is the difference between Preload and Afterload?

Answer 7

Preload

• The stress on the ventricular wall before systole
• Volume of blood in ventricles end of diastole/before systole

Afterload

• Resistance heart has to pump against
• Determined by arterio

Question 8

How do Organic Nitrates impact Preload and Afterload?

Answer 8

Decrease preload
- Dilate veins, decrease stroke volume, and decrase cardiac work

Decrease afterload
- Decreased total peripheral resistance, decreased BP and decreased cardiac work

Question 9

What is an example of a Organic Nitrate that has a large first pass effect?

Answer 9

Nitroglycerin

Comes in sublingual for symptomatic treatment and path for prevention of angina

Large first-pass

Question 10

What is an example of an Organic Nitrate that is used prophylactically?

Answer 10

Isosorbide mononitrate

Comes in oral form due to high bioavailability

Question 11

What 3 anginal situations are Nitrates used for?

Answer 11

1. Acute relief of angina
   - SL or spray
2. Prophylaxis in situations that may provoke angina
   - SL or oral
3. Long-term prophylaxis of angina
   - Transdermal patches
   - Oral

Question 12

What are 3 adverse effects for Organic Nitrates?

Answer 12

1. Headache
   - Classic and predictable
2. Postural hypotension
   - Some peripheral edema
3. Reflex tachycardia
   - Partially offsets beneficial effects

Question 13

How long does it take to develop tolerance to Organic Nitrates?

Answer 13

A day

You can reduce tolerance by removing topical forms at bedtime and applying new doses in the morning

Question 14

What are three B-adrenoceptor antagonists?

Answer 14

1. Atenolol
2. Metoprolol (Lopressor)
3. Propranolol (Inderal)

Question 15

How do Beta-Blockers impact the heart?

Answer 15

Decrease HR = cardiac work

Decreases myocardial contractility = less cardiac work

Question 16

When should Beta-Blockers be used?

Answer 16

*For long-term prevention of angina

Hypertension, cardioprotective effect

Propranolol can be used for migraine headaches

Question 17

What are some adverse effects of Beta Blockers?

Answer 17

1. Cardiovascular
   - Bradycardia, hypotension, HF
2. Metabolic
   - Altered glucose and lipid metabolism
3. CNS
   - Dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams
4. Impotence

Question 18

How do CCB’s help treat angina?

Answer 18

Reduces myocardial contractility which decrease myocardial oxygen demand.

First line treatment for angina and hypertension