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GS Pharmacology > Antianginals > Flashcards

Antianginals Flashcards

1
Q

Blood Flow Equation

A

PA / (RL + RS)

P should actuall be PA-PV, but PV is so small it is ignored

RL = large vessel resistence

RS = small vessel resistence

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2
Q

Angina Pectoris

A

Syndrome of ischemic heart diesease. angina pain occurs when O2 delivery is inadequate for myocardial requirements

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3
Q

Angina of Effort

A

Caused most often by a fixed obstruction which caused narrowing of coronary arteries. When exercise causes an increased demand for myocardial O2, there is an episode of myocardial ischemia and angina results.

Aka stable angina

Beta blockers, Ca channel blockers, & nitrodilators all useful, if single drug is inadequate, can use multiple

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4
Q

Variant Angina

A

Coronary insufficiency caused by localized vasospasm of large coronary vessels.

Can occur at rest or with exercise

Do NOT use beta blocker, but nitrodilators & Ca channel blockers are useful

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5
Q

Unstable Angina

A

Complicated pathology

occurs at rest or when there is a change in the nature of the angina which had previously been stable or when patients without history of angina show frequent and severe angina

**usually caused by thrombosis or ruptured plaque**

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6
Q

Rationale for Drug Therapy

A
  1. Increase O2 delivery
    • coronary vasodilators
      • nitrates
      • Ca2+ blockers
    • anti-thrombrotic & thrombolytic agents
      • asa
      • heparin
      • dipyridamole
      • plasminogen activators
  2. Decrease O2 demand
    • venodilators
      • nitrodilators
    • arterial dilators
      • Ca2+ blockers
      • nitrodilators
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7
Q

Calcium Channel Blockers

A

useful for variant & angina of effort

orally active

inhibit L-type calcium channels, reducing intracellular Ca2+

affects impulse generation in SA node or AV node or calcium dependent action potentials

cardia contractility reduced

reduces peripheral vascular resistence

relaxes/dilates coronary arteries

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8
Q

Dihydropyridines

A
  1. Other Names
    • Nifedepine
    • Amlodepine
    • Nicardepine
  2. Uses: variant angina & angina of effort
  3. Mechanism: Ca channel blocker
    • decreases afterload -> decreases myocardial o2 demand
    • increase coronary blood flow by dilating coronary arteries
  4. Contraindications:CHF
  5. Adverse Effects:
    • hypotension
    • peripherial edema
    • flushing
    • reflex tachycardia
  6. Other:
    • vascular selective
    • less effects on cardiac contractility
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9
Q

Verapamil

A
  1. Other Names: none mentioned
  2. Uses: very advantageous in atrial fibrilllation, flutter & tachycardia, & angina of effort & variant angina
  3. Mechanism: Ca channel blocker
    • reduces Ca2+ current at AV & SA nodes-> decreases cardiac contractility (reduces myocardial o2 demand)-> arteriolar vasodilator (reduces afterload)
  4. Contraindications: CHF
  5. Adverse Effects
    • constipation
    • peripheral edema
    • hypotension
    • bradycardia
    • heart block
    • heart failure
  6. Other: very little vascular selectivity
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10
Q

Diltiazem

A
  1. Other names: none mentioned
  2. Uses: variant & angina of effort
  3. Mechanism: Ca channel blocker
    • vasodilates coronary vessels without as much negative ionotropic effects as Verapamil
  4. Contraindications: CHF
  5. Adverse Effects:
    • bradycardia
    • hypotension
    • peripheral edema
    • heart block
    • heart failure
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11
Q

Nitrodilators

A

NO enters vasular smooth muscle tissue->increases cGMP production->decreases Ca2+ levels->vasodilation

increases coronary blood flow, reduces preload by dilating veins, reduces afterload by dilating arterioles

inhibits platelet aggregation, coronary spasm, & restenosis (narrowing of blood vessels)

increases myocardial O2 to demand ratio

  1. Names: Nitroglycerin, isosorbide dinitrate, amyl nitrite
  2. Uses: all forms of angina & decreases MI size & mortaily
  3. Mechanism: see above
  4. Contraindications: none mentioned
  5. Adverse Effects:
    • TOLERANCE (minimize by low dose interval therapy)
    • orthostatic hypotension
    • tachycardia
    • throbbing headache
    • methemoglobinemia (can lead to tissue hypoxia)
    • toxicity with sildenafil
  6. Other: used in combination with ACE inhibitors & antithrombotics post MI
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12
Q

Nitroglycerin

A
  1. Other names: none
  2. Uses: all forms of angina & decreases MI size & post MI mortality
  3. Mechanism: nitrodilation
  4. Contraindications: none
  5. Adverse Effects: see nitrodilation
  6. Other:
    • usually given sublingually, but can be transdermal paste for longer duration
    • do NOT want to be metabolized by liver
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13
Q

Isosorbide Dinitrate

A

nitrodilator, usually given sublingually

oral preparation for longer duration

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14
Q

Amyl Nitrite

A

Inhalant nitrodilator

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15
Q

Beta Blockers

A
  1. Mechanism:
    • decrease hr, contractility & bp
    • reduce myocardial O2 demand
  2. Uses:
    • chronic stable (extertional) angina
    • angina with recent MI
  3. Differ:
    • receptor subtype selectivity beta 1 or 2
    • intrinsic sympathomimetic activity
    • pharmacokinetics
  4. Adverse Effects:
    • bradycardia, fatigue
    • may exacerbate diabetes, asthma, PVD
    • may cause nightmares
    • may increase triglycerides
    • may decrease HDL cholesterol (good ones)
  5. Contraindications:
    • diabetics
    • asthma patients
    • PVD patients
    • variant angina
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16
Q

Propranolol

A
  1. Other names: Inderal
  2. Uses: hypertension & chronic stable angina
  3. Mechanism: non-selective beta blocker, no ISA
  4. Contraindications: diabetes, asthma & PVD patients
  5. Adverse Effects: see beta blocker card
  6. Other: half life 2-5 hours
17
Q

Nadolol

A
  1. Other names: Corgard
  2. Uses: chronic stable angina & post MI
  3. Mechanism: non-selective beta blocker, no ISA
  4. Contraindications: diabetes, asthma, & PVD
  5. Adverse Effects: see beta blockers
18
Q

Metropolol

A
  1. Other names: Lopressor
  2. Uses: hypertension, chronic stable angina, & post MI
  3. Mechanism: Selective beta 1 blocker
  4. Other:
    • oral formula
    • IV formula for MI
19
Q

Atenolol

A
  1. Other names: Tenormin
  2. Uses: HTN, post MI, & chronic stable angina
  3. Mechanism: selective beta 1 blocker
  4. Other:
    • oral formulation
    • IV formulation for post MI
20
Q

Carvedilol

A
  1. Other names: Coreg
  2. Uses: HTN, post MI, & chronic stable angina
  3. Mechanism: non-selective beta blocker
  4. Other: has alpha blocking properties as well
21
Q

Pindolol

A
  1. partial beta blocker with intrinsic sympathomimetic activity
  2. half life 3-4 hours
  3. less negative inotropic & chronotropic effects than full beta blocker
22
Q

Acebutolol

A

intrinsic sympathomimetic beta blocker

does not appear to alter cholesterol and triglycerides

23
Q

MI prevention

A

A= ASA, ACE inhibitors, antianginals

B= Beta blockers, blood pressure

C= Cholesterol lowering (& cigarettes)

D= Diet (low salt & fat) & diabetes control

E= Education & exercise

GS Pharmacology (4 decks)

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