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*Pharm Exam 4 > Antianginal Drugs > Flashcards

Antianginal Drugs Flashcards

1
Q

What is the most common cause of angina?

A

atherosclerotic CAD

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2
Q

What is variant (Prinzmetal’s) angina due to?

A

vasospasm of coronaries

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3
Q

What is the first line drug treatment for angina?

A

nitrates

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4
Q

Which drug is used to treat hypertensive emergencies?

A

nitroprusside

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5
Q

What are the main clinical indications of organic nitrates?

A
  • angina pectoris
  • hypertensive emergencies
  • CHF
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6
Q

Does nitroglycerin or isosorbide mono/dinitrate act faster?

A

nitroglycerin (due to short HL)

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7
Q

What is the benefit of a nitroglycerin patch or ointment over the SL, buccal, or tablet formulations?

A

the patch and ointment are longer-lasting

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8
Q

Does isosorbide mono or dinitrate have a better bioavailability?

A

dinitrate (mononitrate not very bioavailable)

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9
Q

What are the main adverse effects associated with nitrates?

A
  • exaggeration of therapeutic effects, including orthostatic hypotension, reflex tachycardia (baroreceptor reflex), and headache
  • nitrate tolerance
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10
Q

How can nitrate tolerance be minimized?

A
  • having a nitrate free interval
  • using lowest effective dose
  • using beta-blockers or Ca2+ channel blockers during nitrate free interval
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11
Q

Where are β1 vs. β2 receptors found?

A
  • β1: cardiac muscle

- β2: cardiac muscle, bronchial smooth muscle, vascular smooth muscle (β2 promote relaxation)

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12
Q

Adverse effects associated with β-blockers?

A

bronchospasm, peripheral vasospasm, exaggerated therapeutic effects (ie, bradycardia), CNS effects (insomnia, depression, fatigue), sexual impotence

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13
Q

Contraindications for β-blockers?

A
  • uncompensated CHF (don’t want to further decrease CO)
  • marked bradycardia
  • advanced AV block
  • severe peripheral vasc. disease (due to potential for vasospasm)
  • IDDM (potential for prolonged hypoglycemia)
  • sexual impotence
  • bronchospasm
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14
Q

MOA of ranolazine?

A

inhibition of late Na+ channel, which improves Ca2+ efflux

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15
Q

What are the 2 new classes of antianginal drugs?

A
  • ranolazine

- ivabradine

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16
Q

MOA of ivabradine?

A

selective inhibition of funny current (If) at sinus node, thus reducing slow diastolic depolarization phase (=decreased heart rate)

17
Q

What are the dihydropyridine vs. non-dihydropyridine Ca2+ channel blockers?

A
  • Dihydropyridines: nifedipine, nicardipine, amlodipine

- Non-dihydropyridines: verapamil, diltiazem

18
Q

Which of the calcium channel blockers have more inotropic and chronotropic effects?

A

verapamil and diltiazem more than nifedipine

19
Q

Which of the calcium channel blockers have more vasodilatory effects?

A

nifedipine more than verapamil and diltiazem

20
Q

Which calcium channel blocker is the best for increasing exercise time in patients with angina?

A

verapamil (bradycardic effect is good at reducing cardiac work during exercise)

21
Q

Why might diltiazem be chosen over verapamil, despite decreasing contractility to a lesser degree?

A

diltiazem has limited side effects

22
Q

Which is the only CCB that may be used in patients with systolic heart failure?

A

amlodipine

23
Q

What is the pitfall of nicardipine?

A

it does not decrease cardiac contractility

24
Q

Why does nifedipine cause peripheral edema?

A

because it vasodilates arterioles more than venules=leakage

25
Q

Side effects of this drug include dizziness and constipation.

A

ranolazine

26
Q

An excellent choice for angina pectoris patients with normal sinus rhythm who are unable to take a β-blocker.

A

ivabradine

27
Q

What is the unique side effect associated with ivabradine?

A

Luminous Phenomena

28
Q

How should you treat a heart failure patient who is NOT experiencing reduced EF?

A

lifestyle modifications

29
Q

When would you add a β-blocker to SL nitroglycerin when managing a patient with stable angina?

A

when angina episodes become more frequent

30
Q

If symptoms of angina cannot be controlled with nitroglycerin and β-blockers, how should you proceed?

A

consider a CCB, long-acting nitrate, ranolazine, ivabradine

31
Q

What if a patient does not respond to medication management of angina?

A

consider CABG or PCI

*Pharm Exam 4 (12 decks)

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