B4-050 Treatment of Angina Flashcards
angina occurs when the oxygen need
exceeds the supply
immediate relief of angina
organic nitrates
angina prophylaxis
calcium channel blockers
beta blockers
angina is typically relieved with
rest and/or nitroglycerin
typical location of angina
retrosternal
radiating to left/both arms
classic or variant angina?
atheromatous obstruction of large coronaries, especially with exercise
classic
classic or variant angina?
may require CABG or angioplasty if uncontrolled
classic
classic or variant angina?
spasm or constrication in atherosclerotic coronary vessels
variant
classic or variant angina?
relieved by nitrates and ca channel blockers
variant
oxygen demand is determined by
- contractility
- heart rate
- wall stress
main energy source in heart
fatty acid oxidation
drugs that can shift myocardial metabolism toward glycolysis and reduce oxygen demand without affecting hemodynamics
- trimetazidine
- pFOX inhibitors
oxygen supply depends on
- O2 delivery
- O2 extraction
agents decreasing O2 demand
- beta blockers
- verapamil/dilitiazem
agents that increase o2 supply
- dehydropyridines
- statins
- anti-thrombotics
drugs that can relax vascular smooth muscle work by
- decreasing intracellular Ca (CCB)
- preventing depolarization (nicorandil)
- increasing cGMP (NO)
3 drug groups used to treat angina
- organic nitrates
- CCBs
- beta blockers
organic nitrates, CCBs, beta blockers
decrease myocardial oxygen demand by decreasing:
- HR
- ventricular volume
- blood pressure
- contractility
- reduces intracellular Ca+ concentration, reducing cardiac contractility and work
- recently approved
ranolazine
partially inhibits fatty acid oxidation
trimetazidine
- inhibits xanthine oxidase
- prolongs exercise time in patients with angina
allopurinol
direct bradycardic agent inhibiting the hyperpolarization activated Na+ channel in the SA node
ivabradine
- rho-kinase inhibitor
- reduces coronary vasospasm in experimental animals
fasudil
short acting nitrates
3
- amyl nitrate, inhaled
- nitroglycerin, sublingual
- isosorbide dinitrate
how are different vessel types affected by NO?
- large veins are markedly dilated
- arterioles and precapillary spinchters are dilated less
can potentiate action of NO in angina, causing severe hypotension and MI
sildenafil
can be used to treat cyanide poisoning
NO
effect and result: beneficial nitrate effects
decreased BP and vasodilation
reduced myocardial O2 demand
effect and result: beneficial nitrate effects
reduced ventricular diastolic pressure
improved subendocardial perfusion
effect and result: beneficial nitrate effects
dilation of epicardial arteries
redistribution of coronary flow to ischemic area
effect and result: beneficial nitrate effects
increased collateral flow
improved perfusion to ischemic areas
effect and result: harmful nitrate effects
reflex increases in HR and contractility
increased myocardial O2 demand
effect and result: harmful nitrate effects
reflex tachycardia
reduced perfusion due to shorter diastole
oral nitrates are rapidly metabolized by
hepatic reductase
What two nitrates should be given sublingual for rapid absorption and to avoid hepatic destruction?
- nitroglycerin
- isosorbide dinitrate