Antianginal Medications

Question 1

Angina =

Answer 1

pain when the heart becomes anoxic

 Oxygen demand of the myocardium exceeds the
amount of available oxygen

Question 2

Triggers for angina

Answer 2

– physical exertion
– mechanical stress
– increased contractility, pulse rate and BP

Question 3

Angina occurs more often at

Answer 3

nighttime

midnight to 8 am

Question 4

Oxygen imbalance causes

Answer 4

ischemia

Question 5

Typical (exertional) angina Happensand leads to _____ then If O2 demand exceeds available oxygen, then____ occurs

Answer 5

ischemia

necrosis = myocardial infarction

Question 6

Angina tigers OR brought on by a trigger

Answer 6

– Stress
– Cold
– Hyperventilation

Question 7

Variant (Atypical, Prinzmetal’s) angina differs from regular in that…

Answer 7

Individuals with variant angina have more
alpha 1 receptors than beta 2 receptors in
their coronary arteries (vasoconstriction)

Question 8

When coronary arteries are normal:

Answer 8

– Mainly beta 2 receptors in coronary arteries =
epinephrine causes vasodilation (improves bloodflow to the heart)

– Epinephrine also acts on beta 1, increasing oxygen
demand of the heart

Question 9

Treatment of Unstable Angina

Answer 9

 nitrates
 beta blockers
 calcium channel blockers
 antiplatelet drugs
 antithrombin therapy

Question 10

Nitrites and Nitrates Cause

Answer 10

relaxation of all smooth muscle

Drugs work on endothelial cells that produce nitric
oxide

 Results in arterial and venous vasodilation***

Question 11

Side Effects of Nitrites and Nitrates

Answer 11

 Rash
 Nitrates oxidize hemoglobin to
methemoglobin
– Blood no longer carries oxygen well

 Large doses of nitrites/nitrates for long-term
use decreases oxygen-carrying capabilities
– Symptoms of angina become worse

Question 12

Two Most important thing to remember for beta blockers

Answer 12

decrease workload of the heart by
decreasing cardiac output (afterload) and
arterial pressure, which decreases venous
return, decreases preload and decreases
oxygen demand

decreased oxygen demand decreases
angina

Question 13

Side Effects of Beta Blockers

Answer 13

Bradycardia

Question 14

Beta Blockers Contraindications

Answer 14

in some forms of congestive
heart failure

Contraindicated for variant angina
– Patient does not have enough beta
receptors in coronary arteries, then if block, vasospasm = more angina due to greater oxygen deficit = potentially fatal!