CV Stable and Variant Angina

Question 1

Nitrates

Answer 1

release NO - produce cGMP, cause vasorelaxation, inhibit platelet aggregation. decrease venous/arterial contraction - decrease myocardial O2 demand (stable angina), decrease coronary artery contraction - increase coronary O2 supply (variant angina), decrease preload. sublingual/IV/oral/patch. Adverse headache, hypotension. tolerance, combine with ED drugs

Question 2

β blockers

Answer 2

competitively block β adrenergic R, decrease HR + contractility + arterial blood pressure - decrease afterload + O2 demand. increase coronary flow - increase O2 supply. oral prophylaxis of stable angina, unpredictable for variant angina, decrease mortality after MI. Adverse bronchoconstriction, lethargy, hypoglycemia. Abrupt withdrawal can precipitate angina

Question 3

Ca++ Channel Blockers

Answer 3

dihydropuridine -pine, non-dihydropuridine DV. -pine works better on blood vessels, DV work better on heart. bind to and non-competitively inhibit Ca++ movement. DV decrease HR + contractility - decrease O2 demand. decrease all arterial contraction - increase O2 supply. oral prophylaxis -pine stable angina, DV variant angina (best). do not combine DV with β blockers, many drug interactions

Question 4

Ranolazine

Answer 4

blocks late sodium current, decrease Ca++, decrease wall tension. inhibits FA oxidation, increased glucose use. does not affect BP or HR, increases exercise tolerance, decreases angina. oral prophylaxis of stable angina alone or in combination. well tolerated, efficacy not affected by age or diabetes.