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Pharmo for medic school > Drugs for angina > Flashcards

Drugs for angina Flashcards

1
Q

Three main families for angina

A

Nitrates, betablockers, CCB

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2
Q

Cardiac oxygen demand determined by

A

Rate, contractility, pre and afterload.

Increased pr and afterload increase wall tension

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3
Q

Three forms of angina

A

Stable, variant (prinzmetals or vasospastic, and unstable

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4
Q

Variant angina drugs

A

nitrates or CCBs relax coronary vessels. Beta blockers and ranolazine won’t help (they reduce MVO2)

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5
Q

Nitro vasodilator actions

A

Mostly on veins.
VSM uptakes and conerts to nitric oxide, it needs sulfhydrl groups to do this
Nitric oxide activates guanylyl cyclases which catalyzes formation of cGMP. cGMP dephosphorylates light-chain myosin in smooth muscle (phosphorylated myosin interacts with actin to produce contraction)

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6
Q

MOA nitro

A

Decreases cardiac oxyen demand.
Decrease preload decreases wall tension to decrease MVO2
In variant angina it increases oxygen supply instead of reducing O2 demand as it relaxes spastic arteries

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7
Q

Nitro metabolism

A

5-7 minute half life. Highly lipid soluble

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8
Q

Nitro adverse effects

A

Headache (diminishes over first few weeks of tx), hypotension, reflex tachycardia
Orthostatic hypotension

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9
Q

Nitro and PDE5

A

Both work by increasing cGMP, thats why synergistic effect is so pronounced

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10
Q

Nitro tolerance

A

Can develop over a single day, possibly from depletion of sulfhydryl groups in VSM or depleting mitochondrial aldehyde dehydrogenase which is also needed to convert to nitric oxide
Tolerance reverses quickly (pts on nitro all the time need to take it off for 8 hours)

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11
Q

Nitro timing

A

Subling 1-3 min onset, duration 30-60
Oral 20-45 min
Patch 30-60 minute with 24 hours working

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12
Q

Betablockers angina

A

Good for angina of effort but not for vasospastic angina

Work by decreasing MVO2 by decreasing rate and contractility

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13
Q

CCB

A

Verapamil and dilitazem dilate arterials in cardiac
Nifedipine only in peripheral
All can be used for vasospastic and stable/UA

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14
Q

Ranolzaine

A

Can prolong QT
Doesn’t drop rate, BP or vascular resistance
Reduces sodium and calcium in myocardial cells which may help heart work more efficiently
Interact with CYP3A4 inhibitors (grapefruit juice, CCB except amlodipine)

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15
Q

Two goals of angina therapy

A

Prevention of MI and death

Prevention of ischemia and anginal pain

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16
Q

Three tx goals for UA

A

Anti-ishemic
Antiplatelet
Anticoagulant

17
Q

Nitro indications

A

ACS, pulmonary edema

18
Q

Nitro contras

A

Hypotension
PDE5 use
RVI

19
Q

Nitro dose

A

20mcg/min increase by 10 every 5
0.4mg q 5 prn or until pressure hits 100mmHg
Same for pulmonary edema as ACS

20
Q

Nitro infusion

A

15mg to 250mL of D5W for 60mcg/mL

21
Q

What doesn’t work on prinzmetal

A

Beta blockers

Work by decreasing MVO2 and decrease chrono, dromo and inotropic effects

22
Q

B1 MOA

A

Agonist binds, conformational change in receptor causes a change in G protein (activates) and the alpha subunit dissociates and activates cAMP which activates protein kinase that phosphorylates calcium channels

23
Q

Sides of beta blockers

A

Insomnia, depression, bizarre dreams

24
Q

Metoprolol indications

A

Symptomatic a fib/flutter pressure over 80

25
Q

Contraindications of metoprolol

A 
Hypersensitivity
2nd/3rd degree block
Brady less than 50
Bronchospastic COPD
Severe heart failure
26
Q

Dose of metop

A

5mg q 5 max 15 aim for HR of 110

27
Q

Labetalol receptors

A

Alpha 1 beta 1 and 2 (antihypertensive) indicated for hypertensive crsis

28
Q

Contras to labetalol (trandate)

A 
Hypersen
Severe/prolonged hypotension
HX of airway disease
Overt heart failure
2nd/3rd degree block
cardiogenic shock
severe bradycardia
29
Q

Labetalol dose

A

20-80mg IV over 2 minutes
Repeat 40-80 q 2 max of 300
Infusion at 0.5-2mg/minute

30
Q

Verapamil (isoptin) class

A

CCB, antihypertensive, antiarrhythmic

31
Q

Verapamil indications

A

SVT, atrial tach, junctional tach, afib/flutter, MAT

32
Q

Verapamil contras

A 
Hypersen
2nd/3rd degree block
Hypotension
V-tach
WPW with afib
Acute MI
Sick sinus
33
Q

Verapamil dose

A

2.5-5mg SIVP over 2 minutes

Repeat 5-10mg in 15-30 mins max 20mg

34
Q

Diltiazem (cardizem)

A

CCB, anti hypertensive, antiarrhytmic

35
Q

Diltiazem (cardizem) contras

A 
Hyper sens
2nd/3rd degree hrt block
hypotension
V-tach
WPW with a fib
Acute MI
Sick sinus
36
Q

Diltiazem (cardizem) indications

A

Afib/flutter

PSVT

37
Q

Diltiazem dose

A

0.25mg/kg SIVP over 2 minutes

Repeat after 15 at 0.35mg/kg

Pharmo for medic school (26 decks)

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