CVS Drugs Part 2 Angina Flashcards
Treatment of Angina
angina pectoris
recurrent chest pain or discomfort when part/some of the heart does not get enough oxygen caused by an imbalance between oxygen demand and oxygen supplied by the coronary vessels = symptom of CAD
stable/effort angina
most common form of chest pain that slowly comes on with increasing intensity and then slowly fades away usually lasting 2-15 minutes, the pattern stays the same and the amount of effort to trigger pain does not alter over time
unstable angina or evolving acute MI
new onset chest pain that occurs with increased intensity, frequency, and duration or occurs at rest and required progressively less effort to cause pain
vasospastic or variant angina
chest pain with uncommon or episodic pattern caused by coronary artery spasm causing decreased blood flow to the heart muscle (occurs at rest and unrelated to physical activity, HR, or BP)
ideal HR formula
(220 - age) x 0.75
most important factor affecting myocardial oxygen demand
heart rate where increased heart rate increases the heart’s oxygen consumption
chronotropic drugs MOA
increase rate of myocardial contraction
inotropic drugs MOA
increase the strength of myocardial contraction
beta-blocker indications for angina
used as initial antianginal therapy and to help reduce the risk of death and MI in patients with a prior history, less effective for angina treatment in CKD than other agents
beta-blocker contraindications
patients with vasospastic angina
beta-blocker adverse effects
rebound angina, MI, and HTN (if not tapered off over 2-3 weeks) bradycardia, cold hands and feet, fatigue, nausea, weakness, dizziness, dry mouth, skin, and eyes, and weight gain
CCB contraindications
pre-existing conduction disorders (AV block and sick sinus syndrome), heart failure, symptomatic hypotension, ACS, grapefruit juice
CCB adverse effects
lightheadedness, hypotension, bradycardia, constipation, and swelling in ankles/feet
CCB clinical indications
used to treat effort and vasospastic angina
Amlodipine/Felodipine MOA
dihydropyridine CCB with a greater effect on smooth muscle in peripheral vasculature and a minimal effect on cardiac conduction
Nifedipine MOA
dihydropyridine CCB that dilates smooth muscle in peripheral vasculature but can also decrease coronary perfusion and increase heart rate and oxygen demand
Nifedipine contraindications
patients with a history of MI and in heart failure
Nifedipine adverse effects
same as other CCBs + increased heart rate and oxygen demand, rebound vasoconstriction if stopped abruptly
Diltiazem MOA
non-dihydropyridine CCB with immediate onset of action on myocardium
Verapamil MOA
non-dihydropyridine CCB that mainly affects the myocardium with greater negative inotropic effect than amlodipine
Nitrate MOA
release nitric oxide activating guanylyl cyclase and increasing formation of cyclic GMP resulting in vascular smooth muscle dilation (venous mostly), reduction in preload and myocardial wall tension, reduction in myocardial oxygen demand, and reduction in arterial resistance (afterload)
Nitrate contraindications
coadministration with PDE-5 inhibitors (Sildenafil), severe anemia, right-sided inferior wall MI (preload dependent), increased ICP, and circulatory failure and shock
Nitrate adverse effects
headache, dizziness, lightheadedness, nausea, flushing, and hypotension
Nitroglycerin (Nitrostat/Nitrolingual) clinical indications
administered sublingually for the treatment of anginal attacks with a fast onset of action and metabolism
