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HLST220: Pharmacology > Chapter 54: Drugs for Angina Pectoris > Flashcards

Chapter 54: Drugs for Angina Pectoris Flashcards

1
Q

What is angina pectoris

A
  • sudden pain beneath the sternum, often radiating to the left shoulder and arm
  • oxygen supply to the heart is insufficent to meet oxygen demand
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2
Q

what are the 2 goals of angina drug therapy

A
  • prevention of myocardial infraction and death
  • prevention of myocardial ischemia and anginal pain
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3
Q

what are angina triggers

A

4 E
- eating a large meal
- exercise and other physical activity
- emotions
- extreme cold weather

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4
Q

treatment strategy of chronic stable angina (exertional)

A
  • increase cardiac oxygen supply
  • decrease oxygen demand
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5
Q

Chronic stable angina therapeutic agents

A
  • Organic nitrates (Nitroglycerin)
  • beta blockers (Metoprolol and propranolol
  • calcium channel blockers (verapamil or nifedipine)
  • Atrial- selective sodium channel blocker (ranolazine)
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6
Q

Chronic stable angina (exertional) nondrug therapy treatment

A
  • avoid factors (overexertion, heavy meals, stress, exposure to cold)
  • decrease risk factors (smoking, hyperlipidema, hypertension, sedentary lifestyle)
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7
Q

what is variant Angina (prinzmetal)

A

coronary artery spasm which restricts blood flow

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8
Q

Variant Angina treatment strategy

A
  • reduce severity and incidence of attacks
  • increase cardiac oxygen supply
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9
Q

variant angina therapeutic agents

A
  • calcium channel blockers
  • organic nitrates
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10
Q

varient angina often occurs

A

during rest

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11
Q

what is unstable angina

A
  • severe CAD complicated by vasospasm, platelet aggregation, transient coronary emboli
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12
Q

what are the symptoms of unstable angina

A
  • angina at rest
  • new onset exertional angina
  • intensification of existing angina
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13
Q

unstable angina treatment strategy

A
  • maintain oxygen supply
  • decrease oxygen demand
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14
Q

therapeutic agents for unstable angina

A
  • anti-ischemic therapy
  • antiplatelet therapy
  • anticoagulant therapy
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15
Q

nitroglycerin dose

A
  • three doses sublingually every 5 mins (tablet or spray), followed by IV therapy if perisitant ischemia or hypertension occurs
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16
Q

beta blockers does

A

give first dose IV if chest pain is ongoing

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17
Q

Acetylsalicylic acid should be used

A

indefinitely

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18
Q

Acetylsalicylic acid examples

A

Aspirin
- Clopidogrel [Plavix]
- Ticlopidine [Ticlid]

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19
Q

Anticoagulant therapy examples

A
  • subcutaneous LMW heparin
  • direct thrombin inhibitors
  • factors Xa inhibitors
  • IV unfractionated heparin
20
Q

Nitroglycerin [Nitrospray] MOA

A

acts directs on vascular smooth muscle to promtote vasodialtion (primarily in the veins)

21
Q

Nitroglycerin [Nitrospray] is used for

A

stable and variant angina

22
Q

Nitroglycerin [Nitrospray] pharmacokinetics

A
  • t1/2: 5-7 mins
  • large first pass effect
23
Q

Nitroglycerin [Nitrospray] adverse effects

A
  • headache (severe but diminishes over time)
  • orthostatic hypotension
  • reflex tachycardia
24
Q

Nitroglycerin drug interactions

A
  • hypotensive drugs
  • Phosphodiesterase type 5 inhibitors (sildenafil [viagra])
25
Q

nitroglycerin negative effect

A

tolerance

26
Q

nitroglycerin translingual spray

A
  • prime before use
27
Q

nitroglycerin transdermal delivery systems

A

every 12 hours

28
Q

nitroglycerin IV infusion

A
  • slow infusion rate intially, continuous CV monitoring, diluted before administration, dont mix with other drugs
29
Q

nitroglycerin long acting preperations examples

A
  • Isosorbide dinitrate [Isordil]
  • Isosorbide monitrate
30
Q

Nitroglycerin long acting preperations therapeutic uses

A
  • long tern prophylaxis
31
Q

long acting preperations adverse effects

A

headache, hypotension, and reflex tachycardia

32
Q

beta blockers examples

A
  • propranolol
  • metoprolol
33
Q

beta blockers adverse effects

A
  • bradycardia
  • decreased atriventricular (AV) conduction
  • reduction of contractility
  • asthmatic effects
  • insomnia
  • depression
34
Q

beta blockers should be used in caution in patients with

A

diabetes

35
Q

calcium channel blockers examples

A
  • verapamil
  • diltiazem
  • nifedipine
36
Q

calcium channel blockers are used for

A

stable and variant angina

37
Q

calcium channel blockers adverse effect

A
  • dilation of peripheral arterioles leads to reflex tachycardia
38
Q

late sodium current inhibitor example

A

ranolazine [corzyna]

39
Q

Icosapent Ethyl [Vascepa] effects on ECG

A

causes QT prolongation

40
Q

Icosapent Ethyl [Vascepa] side effects

A

dizziness, headache, constipation, nasuea

41
Q

Icosapent Ethyl [Vascepa] contradictions

A
  • concurrent use with strong CYP P450 3A4 drugs
  • severe renal or hepatic impairment
42
Q

Icosapent Ethyl [Vascepa] dose

A

BID,
** do not crush

43
Q

other drugs used for angina pectoris

A
  • antiplatelets
  • antihyperlipidemics
  • ACEI
44
Q

initial therapy of variant angina

A

calcium channel blockers or long acting nitrate

45
Q

what is not effective with vasospastic angina

A

beta blockers

HLST220: Pharmacology (46 decks)

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