CV & Renal: Anti-Anginal

Question 1

Transient Ischemia due to imbalance between O2 Supply & O2 Demand leads to…

Answer 1

angina

Question 2

Classic or variant angina?

Etiology: obstruction of coronary vessels w/ exercise

Tx: Drugs, or CABG or Angioplasty

Answer 2

Classic “Angina of Effort”

Question 3

Classic or variant angina?

Etiology: Spasm/Constriction in atherosclerotic vessels

Tx: Nitrates or CCBs

Answer 3

Variant

Question 4

Ischemia can be relieved by increasing O2 supply or decreasing demand… what is the major mechanism used pharmacologically?

Answer 4

decrease demand

Question 5

Which drugs have the following mechanism?

↑ Endothelial NO →

↑ Guanylyl Cyclase →

↑ cGMP →

↑ Dephosphorylation of Myosin LC →

Relaxation

Answer 5

Nitroglycerine and isosorbide dinitrate

Question 6

Do nitrates and nitrites cause even vasodilation?

Answer 6

no, large veins dilated more than arterioles

Question 7

Nitrates/nitrites are DOC for which kinds of acute angina?

Answer 7

classic and variant

Question 8

Which drug class has the following adverse effects?

Acute Toxicity → Profound Vasodilation → Throbbing headache, hypotension, tachy

Tolerance w/ repeat exposure

Answer 8

Nitrates/Nitrites

Question 9

Describe the kinetics of PO nitrates/nitrites…

Answer 9

high first pass

Question 10

CCBs relax calcium dependent smooth muscle by binding L-type calcium channels, making them good for treating acute or chronic angina?

Answer 10

chronic

Question 11

Which CCB can be formulated as slow release for tx of angina?

Answer 11

nifedipine

Question 12

What adverse effects can nifedipine and dihydropyridines have?

Answer 12

Baroreflex mediated ↑ MI development

Question 13

What adverse effects can Verapamil & Diltiazem have?

Answer 13

cardiac depression leading to AV Block, HF, Cardiac Arrest

Question 14

This drug class exerts the following effects on these tissues:

Heart: ↓ CO
Kidneys: ↓ Renin
CNS: ↓ SNS tone

Answer 14

Beta blockers

Question 15

Do beta blockers directly cause vasodilation?

Answer 15

no

Question 16

Are beta blockers helpful or hurtful in variant angina? why?

Answer 16

hurtful

↓ HR & ↑ Ejection time → ↑ LV EDV → ↑ O2 Demand

Question 17

Which drug class has the following adverse effects?

Bronchoconstriction
↑ TGs
↓ insulin & hypoglycemic response
Harmful in variant angina

Answer 17

beta blockers

Question 18

Which drug is a partial fatty acid oxidation inhibitor, leading to decreased oxygen consumption and decreased contractility?

Answer 18

Ranolazine

Question 19

Which drug has the following therapeutic effects?

↓ LV stiffness, ↑ coronary flow

Drug of last resort

Answer 19

Ranolazine

Question 20

Variant angina is treated with what two classes?

Answer 20

Nitrates (acute)

CCBs (chronic)

Question 21

What is the most effective combination therapy for angina tx?

Answer 21

beta blocker and vasodilator

Question 22

This drug class inhibits cGMP specific PDE5 enzymes, leading to increased cGMP and vasodilation

Answer 22

sildenafil

Question 23

What two conditions can sildenafil treat?

Answer 23

ED

Pulmonary HTN

Question 24

A patient complains of blue tinged vision and photophobia. Which drug has those SFx?

Answer 24

Sildenafil

Question 25

Which drug has the following contraindications? ``` Pregnant or lactating women or infants/children If nitrates/nitrites contraindicated Use w/ alpha blockers → hypotension Use w/ P3A4 inhibitors “-ivir” “-azole” Cimetidine “-omycin” Quinidine/Quinine Zafirlukast/Zileuton ```

Answer 25

PDE5 Inhibitors

Question 26

Which PDE5 inhibitor achieves maximum concentration within 15 minutes of onset?

Answer 26

Vardenafil (levitra)

Question 27

Which PDE5 Inhibitor has a 24-36 hour duration of action?

Answer 27

tadalafil (cialis)