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Pharmacology > Cardiovascular Meds: chest pain > Flashcards

Cardiovascular Meds: chest pain Flashcards

1
Q

Specify the cause of cardiac chest pain

A

The cause is inadequate oxygen to the heart muscle

Important point to think: is it a demand issue or a supply issue?

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2
Q
A

Cardiac chest pain feels differently to individuals! (It does not always feel like a pain)

  1. pressure, fullness, burning or tightness in your chest
  2. crushing/searing pain that radiates to your back, neck, jaw, shoulders, and arms
  3. cold sweats
  4. dizziness/weakness
  5. shortness of breath
  6. nausea/vomitting
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3
Q

List 4 families of anti-anginal agents with examples of each

A
  1. organic nitrate (e.g. nitroglycerin)
  2. beta blockers (propranolol, metoprolol)
  3. calcium channel blockers (verapamil)
  4. renolazine (a newer drug!)
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4
Q

Compare the 3 types of angina pectoris: Prinzmetal’s angina, chronic stable angina, and unstable angina

A

Prinzmetal (variant) angina
- caused by vasospasm
- supply ischemia

Chronic stable (exertional) angina
- ppt has a fixed stenosis due to coronary artery disease or something –> feel chest pain when they do physical exercises
- demand ischemia (O2 demand exceeds normal O2 supply)

Unstable angina
- medical emergency! –> do not want it to become the infarct
- caused by thrombus
- supply ischemia

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5
Q

List 3 factors that affect the oxygen supply to the heart

A
  1. Heart rate –> too fast & too low will cause some issues with oxygen supply
  2. oxygen content of blood (e.g. lung disease)
  3. coronary perfusion
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6
Q

Identify the drugs used to treat the following causes of angina: vasospasm, fixed stenosis, thrombosis, high heart rate, increased afterload, and increased preload

A

Vasospasm: nitrates, CCBs

Fixed stenosis: nitrates, CCBs, beta blockers, angioplasty or stents

thrombosis: thrombolytics, antiplatelets

high HR: CCBs and beta blockers

increased afterload: CCBs, beta blockers, anti-hypertensive drugs

increased preload: CCBs, beta blockers, ranolazine!

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7
Q

Chronic stable angina

List the four triggers

A
  1. emotional excitement
  2. large meals
  3. cold exposure
  4. coronary artery disease (CAD)

Don’t shovel snow on the snow day!

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8
Q

Chronic stable angina

List 4 drugs that provide symptomatic relief in chronic stable angina

A
  1. nitrates

For daily basis,
2. CCBs
3. beta blockers
4. ranolazine

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9
Q

Chronic stable angina

Specify 2 non-drug interventions for chronic stable angina

A
  1. Avoid risk factors
  2. Consider PCI (percutaneous coronary intervention; angioplasty or stent) OR CABG (coronary artery bypass graft)
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10
Q

Prinzmetal (variant) angina

Describe the pathophysiology of variant/Prinzmetal’s angina

A

Caused by coronary artery spasm
<– damage / dysfunction of endothelial cells
smooth muscle hyperactivity

Happens most often at night (that’s creepy!)
<–because vagal tone is higher at night

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11
Q

Prinzmetal (variant) angina

List 2 therapeutic agents used for variant angina

A
  1. nitrates
  2. CCBs

Beta blockers NOT USED for variant angina!!!

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12
Q

Unstable angina

Describe the 4 immediate priorities of the acute treatment of unstable angina to prevent infarction

A

MONA

Morphine (use if pain not relieved by nitroglycerin)
Oxygen (use if sat is below 90%, respiratory distress)
Nitrates
Aspirin

***the clot can be a rupture of plaque + platelet aggregation = thrombus

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13
Q

Describe the role of nitroglycerin when used in stable & unstable angina

A

Decreases cardiac O2 DEMAND !!!

Nitroglycerin dilates veins
–> more blood stays in the extremities
–> preload (blood returning to the heart) decreases
–> cardiac O2 demand decreases!

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14
Q

Describe the role of nitroglycerin when used in variant angina

A

Decreases cardiac O2 SUPPLY!

Nitroglycerin can relaxes coronary arteries
–> oxygen supply increases

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15
Q

List 3 side effects of nitrates

A

Headaches
Hypotension (low BP)
reflex tachycardia (baro reflex)

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16
Q

List other options of organic nitrates besides nitroglycerin

A

Isosorbide mononitrate
Isosorbide dinitrate

Amyl nitrate (ultrashort-acting agent used to treat acute angina)

17
Q

Identify the routes of administration of nitroglycerin for the treatment of acute angina

A

Sublingual tablets OR translingual spray

18
Q

Identify the routes of administration of nitroglycerin for the long-term prophylactic treatment of angina

A

Transdermal patches OR sustained-release oral capsules

19
Q

Identify the routes of administration of nitroglycerin for abortion of the ongoing attack and anticipation of exertion

A

Sublingual tablets OR translingual spray

20
Q

identify the interactions of nitroglycerin with phosphodiesterase type 5 inhibitors

A

Taking erectile dysfunction drugs (sildenafil, tadalafil, avanafil) with NTG can cause life-threatening hypotension

21
Q

Recognize the drug interaction between nitroglycerin and beta blockers, verapamil, and diltiazem

A

BBs, verapamil, and diltiazem can be used to treat NTG induced reflex tachycardia

22
Q

Specify the 3 therapies used in the acute treatment of unstable angina

A
  1. Anti-ischemic therapy
    ***ischemia = inadequate blood supply to heart muscles
  2. Anti-platelet therapy
  3. Anti-coagulant therapy
23
Q

List 4 drugs used for the anti-ischemic therapy of unstable angina

A
  1. nitroglycerin
  2. oxygen
  3. beta-blocker
  4. ACE inhibitor OR ARBs (patients with LV dysfunction)
24
Q

Describe the role of beta blockers in the acute treatment of unstable angina

A

Directly decreases HR and contractility
–> workload of the heart decreases
–> less need for oxygen

Also used for post MI

25
Q

**Describe 4 drugs used for anti-platelet therapy in unstable angina

A
  1. Aspirin indefinitely
  2. Clopidogrel for 2 months
  3. Abciximab only if angioplasty is planned
  4. Eptifibatide when angioplasty is not planned
26
Q

Describe 3 drugs used for anticoagulant therapy in unstable angina

A
  1. SubQ LMW heparin (e.g. enoxaparin) or IV UF heparin
  2. Direct thrombin inhibitor (bivalirudin)
  3. Factor Xa inhibitor (fondaparinux)
27
Q

List 4 drug classes that are prophylactically used long term to prevent myocardial infarction and death, along with an example drug in each drug class

A
  1. Antiplatelets drug
  2. Anti-anginal agents
    (BB, CCB, long-acting nitrates)
  3. ACE inhibitors
  4. cholesterol-lowering drugs
28
Q

Give an example of a vasodilator that targets arterioles

A

Hydralazine

Dilates primarily arterioles –> low BP & decreases cardiac afterload (FOC of LV decreases!)

29
Q

Give an example of a vasodilator that target veins

A

Nitroglycerin

Dilates primarily –> decreases cardiac preload

30
Q

Give an example of a vasodilator that vasodilates both arterioles and veins

A

Prazosin / Nitroprusside

31
Q

What happens when veins dilate?

A

Decreased preload
–> heart pumps out relatively less blood/min
–> less cardiac output
–> less tissue perfusion

This is good when the heat suffers!

32
Q

What happens when arterioles dilate?

A

Decreased afterload
–> the heart pumps out relatively more blood/min (because it is now easier to lift up things!)
–> more cardiac output
–> more tissue perfusion

Pharmacology (20 decks)

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