CVS Drugs Part 2 Angina

Question 1

angina pectoris

Answer 1

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

Question 2

stable/effort angina

Answer 2

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

Question 3

unstable angina or evolving acute MI

Answer 3

new onset chest pain that occurs with increased intensity, frequency, and duration or occurs at rest and required progressively less effort to cause pain

Question 4

vasospastic or variant angina

Answer 4

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)

Question 5

ideal HR formula

Answer 5

(220 - age) x 0.75

Question 6

most important factor affecting myocardial oxygen demand

Answer 6

heart rate where increased heart rate increases the heart’s oxygen consumption

Question 7

chronotropic drugs MOA

Answer 7

increase rate of myocardial contraction

Question 8

inotropic drugs MOA

Answer 8

increase the strength of myocardial contraction

Question 9

beta-blocker indications for angina

Answer 9

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

Question 10

beta-blocker contraindications

Answer 10

patients with vasospastic angina

Question 11

beta-blocker adverse effects

Answer 11

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

Question 12

CCB contraindications

Answer 12

pre-existing conduction disorders (AV block and sick sinus syndrome), heart failure, symptomatic hypotension, ACS, grapefruit juice

Question 13

CCB adverse effects

Answer 13

lightheadedness, hypotension, bradycardia, constipation, and swelling in ankles/feet

Question 14

CCB clinical indications

Answer 14

used to treat effort and vasospastic angina

Question 15

Amlodipine/Felodipine MOA

Answer 15

dihydropyridine CCB with a greater effect on smooth muscle in peripheral vasculature and a minimal effect on cardiac conduction

Question 16

Nifedipine MOA

Answer 16

dihydropyridine CCB that dilates smooth muscle in peripheral vasculature but can also decrease coronary perfusion and increase heart rate and oxygen demand

Question 17

Nifedipine contraindications

Answer 17

patients with a history of MI and in heart failure

Question 18

Nifedipine adverse effects

Answer 18

same as other CCBs + increased heart rate and oxygen demand, rebound vasoconstriction if stopped abruptly

Question 19

Diltiazem MOA

Answer 19

non-dihydropyridine CCB with immediate onset of action on myocardium

Question 20

Verapamil MOA

Answer 20

non-dihydropyridine CCB that mainly affects the myocardium with greater negative inotropic effect than amlodipine

Question 21

Nitrate MOA

Answer 21

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)

Question 22

Nitrate contraindications

Answer 22

coadministration with PDE-5 inhibitors (Sildenafil), severe anemia, right-sided inferior wall MI (preload dependent), increased ICP, and circulatory failure and shock

Question 23

Nitrate adverse effects

Answer 23

headache, dizziness, lightheadedness, nausea, flushing, and hypotension

Question 24

Nitroglycerin (Nitrostat/Nitrolingual) clinical indications

Answer 24

administered sublingually for the treatment of anginal attacks with a fast onset of action and metabolism

Question 25

Isosorbide mononitrate clinical indications

Answer 25

taken daily for the prevention of angina with 1-2 hour onset and 5-12 hour duration of action

Question 26

Isosorbide dinitrate clinical indications

Answer 26

sublingual or immediate-release tablet used for the prevention of acute angina with either a 2-5 minute onset and 1-2 hour duration of action for sublingual or a 20-40 minute onset and 4-6 hour duration of action for immediate release

Question 27

ranolazine MOA

Answer 27

sodium channel blocker that inhibits the late phase of sodium current thereby improving oxygen supply and demand and improving diastolic function

Question 28

ranolazine clinical indications

Answer 28

used to treat angina and arrhythmias when other medications have failed

Question 29

ranolazine adverse effects

Answer 29

drugs interactions and can prolong QT interval

Question 30

why combinations of nitrates with beta-blockers or CCBs are used in the treatment of angina

Answer 30

these combinations are useful if there is intolerance to a drug or if angina symptoms persist despite the optimal dosage of a single drug, these combinations also decrease the degree of cardiac ischemia and can improve exercise tolerance

Question 31

why the combination of nitrate and sildenafil is potentially dangerous

Answer 31

both sildenafil and nitrates cause vasodilation and coadministration can lead to the lowering of BP and blood flow that can precipitate an MI

Question 32

Phosphodiesterase-5 inhibitors (PDE5)

Answer 32

sildenafil, avanafil, tadalafil, and vardenafil

Question 33

interventional angina therapy (stenting) indications

Answer 33

used to improve symptoms when optimal medication therapy has failed or when coronary arteries are significantly narrowed, many coronary arteries are narrowed, or the left main coronary artery is narrowed

Question 34

downside of stenting

Answer 34

has not been shown to prolong life compared with medical therapy and can be associated with higher incidence of short-term events