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Cardio Pharm > Antianginals > Flashcards

Antianginals Flashcards

1
Q

Nitrates– effects low vs high dose

A

Low dose: increase venous capacitance, reduce preload

High dose: Arterial dilation, decrease PVR and BP (afterload). Dilates epicardial coronary vessels

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2
Q

Nitrates indication

A

All Type of Angina

Acute Angina Attack & Prophylaxis

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3
Q

Nitrates MOA

A

Biotransformation NO
*in mitochondria

Activation of Guanylate Cyclase [cGMP] Activation of MLC Phosphatase Smooth Muscle Relaxation

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4
Q

Nitrates metabolism?

A

Isosorbide Mono/Dinitrate are prodrugs, activated by 1st pass

Avoid continuous exposure, must not use 10-14 hrs/day

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5
Q

Nitrates should be given as (A) due to extensive (B)

A

A- sublingual/spray

B- 1st pass metabolism

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6
Q

Nitrates are activated by (A) therefore they are less effective in which population (B)?

A

A- ALDH2 and P450 dehydrogenase

B- Asians with SNP in ALDH2– those who get asian flush

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7
Q

Nitrates should not be taken with (A) due to (B)

A

A- Sildenafil (viagra)

B- risk for critical hypotension

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8
Q

BBlockers are indicated for…

A

Stable or Unstable Angina

NOT variant Angina

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9
Q

Selective BB? Non selective BB?

A

Nonselective:
Propranolol
Nadolol
Timolol

Selective:
Acebutolol
Atenolol
Metoprolol
Labetalol
Pindolol
Carvedilol
Nebivolol
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10
Q

Effects of BBlockers

A

decrease HR /BP

decrease Exercise-induced increase in HR & Contractility

Block Sympathetics

Prevent Reflex Tachycardia from Nitrates

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11
Q

Nitrates can cause reflex (A), which can be prevented with (B)

A

A- tachycardia

B- BBlockers

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12
Q

Lipid soluble BBlockers are eliminated by…

A

liver

propanolol
metoprolol

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13
Q

Hydrophilic BBlockers are eliminated by …

A

kidneys

nadolol
atenolol

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14
Q

Beta 3 agonist and Beta 1 antagonist?

A

Nebevolol

renal elimination

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15
Q

Beta 3 agonist and Beta 1 antagonist?

A

Nebevolol

renal elimination

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16
Q

nonselective BBlocker/a Blocker

A

Labetolol/carvedilol

decrease IP3, decrease Ca release to cause vasodilation

17
Q

Indications for Ca Channel blockers

A

Stable or Variant Angina

“-pine” = dyhydropyridine

Ca channels are different splice variants b/w vascular smooth muscle and heart

18
Q

Examples of Ca channel blockers

A

Dilitazem
Verapamil

-PINE = dihydropyridines
amiodipine
nicardipine
nifedipine
nimodipine
19
Q

MOA of Diltiazam and Verampamil?

A

Selective Antagonist for Heart:
Activity of Voltage Dependent Ca++ Channel Activity
(L-type channels)

Decrease HR

20
Q

Ca Channel blockers are metabolized by …

A

CYP3A4- many interactions!

21
Q

Ca channel blockers AE

A

Diltiazem
Verampamil

Bradycardia, AV Node conduction, - inotropy, Edema/Headache, Constipation

22
Q

Nicardipine is an example of a (A) which is a (B) antagonist for (C) and acts on (D) to cause (E)

A

A- Ca Channel blocker/ dihydropyridine

B- selective

C- arterioles

D- Ca Ltype channels

E- vasodilation

23
Q

Dihydropyridines systemic effects

A

decrease PVR and BP, Decrease afterload

24
Q

Dihydropyridines AE

A

Could Cause Reflexive Tachycardia, in reponse to BP
Fewer adverse effects with Long Acting (Amlodipine) or Sustained Release (Nifedipine)
*Long-acting: Peripheral Edema, Headache
*Short-acting: Hypotension, Reflex tachycardia, MI risk, & peripheral edema, headache

25
Q

Who’s the oddball? When is it used?

A

Ranolazine!

for stable angina only, but not as first line

26
Q

Ranolazine acts on which ions?

A

Cardiac: Late Na+ Current Blocker

Prevents accumulation of Na and Ca during ischemia, which would activate myo-filaments

27
Q

Don’t mix ranolazine with (A) because (B).

A

Do not mix with Verapamil or Diltiazem

*Goes through 1st Pass Metabolism by CYP3A4

28
Q

Ranolzine AE

A

Long QT- TdP

29
Q

DHP are contraindicated with..

A

hypotension

30
Q

Verampamil and diltiazem are contraindicated with …

A

HF
AV conduction defects
B Blockers

31
Q

CCB should not be used with …. stenosis

A

Aortic

32
Q

Summary

A

nitrates: relieve/prevent all angina

BBlockers: prevent un/stable angina, reduce mortality s/p AMI

CCB: prevent stable or variant angina

Ranolazine: treats stable angina if standard tx is inadequate

Antiplatelet agents: decrease rick of CV AE

antihyperlipidemic agents: decrease incidence of ischemia/ CV AE

Cardio Pharm (6 decks)

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