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PHTH 561: Pharmacology > Drugs for Angina and Heart Failure > Flashcards

Drugs for Angina and Heart Failure Flashcards

1
Q

What is angina pectoris/angina?

A

Severe chest pain due to ischemia of the heart muscle

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2
Q

What is the incidence of angina in the US?

A

9 million Americans experience angina

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3
Q

What types of angina are there?

A

-Stable angina
-Unstable angina
-Variant/Prinzmetal angina

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4
Q

What is oxygen supply and demand?

A

The amount of oxygen that the heart needs and the amount of oxygen that is supplied to the heart

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5
Q

What is atherosclerosis?

A

Fatty plaques that can build up in the coronary arteries

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6
Q

What is coronary artery spasm?

A

A temporary tightening or spasm of the coronary arteries which can decrease blood flow

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7
Q

What conditions can lead to reduced oxygen delivery?

A

-Anemia
-Respiratory diseases

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8
Q

What is the pathogenesis of class angina due to atherosclerosis?

A

-In a patient with atherosclerosis, there is dilation of arterioles at rest to compensate for increased blood flow resistance from plaque
-During exercise, further dilation cannot occur which leads to myocardial ischemia and pain

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9
Q

What are the symptoms of stable angina?

A

-Usually occurs during physical exertion (stable)
-Usually lasts for short periods of time
-Relieved by rest or medicine
-May feel like chest pain that spreads to the arms, back, or other areas

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10
Q

What are risk factors for angina?

A

-Age (≥ 55 for men, ≥ 65 for women)
-Family history
-Cigarette smoking
-Physical inactivity
-Medications
-Chronic stress
-HTN
-Diabetes mellitus
-Kidney disease
-Obesity
-Dyslipidemia

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11
Q

What is stable angina?

A

-Most common form
-Effort induced angina
-Due to reduction in blood flow from atherosclerosis
-Symptoms are relieved by rest or nitroglycerin

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12
Q

What is unstable angina?

A

-Angina caused by blocking of the coronary arteries by blood clots
-Chest pain occurs with increased frequency
-Not relieved by rest of medication
-Requires hospital admission and more aggressive therapy
-Can lead to MI and death

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13
Q

What is Prinzmetal’s/Variant angina?

A

-Angina due to coronary artery spasm
-Attacks are unrelated to physical activity, HR, or blood pressure
-Responds to coronary vasodilators such as nitroglycerin and calcium-channel blockers

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14
Q

What are the classes of drugs that are used to treat angina?

A

-Non-selective β-blockers
-β-1 blockers (cardioselective)
-Calcium channel blockers
-Nitrates
-Sodium channel blockers

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15
Q

Which drugs increase the oxygen supply to the heart?

A

-β-blockers
-Nitrates
-Calcium channel blockers

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16
Q

Which drugs decrease the oxygen demand of the heart?

A

-β-blockers
-Calcium channel blockers

17
Q

What drug is NOT effective in treating variant angina? Why?

A

-β-blockers
-They do not counteract vasospasm

18
Q

What different organic nitrates are there that are used for the treatment of angina? What do they do?

A

-Nitroglycerin
-Isosorbide dinitrate
-Isosorbide mononitrate
-Cause a rapid reduction in myocardial oxygen demand
-Used for all types of angina

19
Q

What is the mechanism of action of organic nitrates?

A

-Relax vascular smooth muscle by their intracellular conversion to nitric oxide, which increased guanylate cyclase and increases cyclic guanosine monophosphate (cGMP)
-Elevated cGMP leads to dephosphorylation of the myosin light chain

20
Q

What are the two major effects of nitroglycerin?

A

-Dilation of large veins, which decreases preload/venous return to the heart which reduces work of the heart
-Dilates coronary vasculature which provides increased blood flow to the heart

21
Q

What is the preferred method of administration for nitroglycerin and isosorbide dinitrate? Why?

A

-Sublingual
-Because sublingual has a much faster onset of action (1-3 min.) compared to oral administration (35 min.)
-There is a significant first-pass rate of nitroglycerin in the liver if given orally

22
Q

What is the preferred method of administration for isosorbide mononitrate?

A

Oral extended release because it is more stable against liver breakdown and has longer duration of action

23
Q

What are adverse effects of organic nitrates?

A

-Headache
-Orthostatic hypotension
-Facial flushing
-Reflex tachycardia

24
Q

What drug is organic nitrates contraindicated with? Why?

A

Sildenafil (Viagra) to prevent dangerous hypotension

25
Q

How are β-blockers used to treat angina?

A

-Decrease oxygen demands by lowering HR and force of contraction
-Decreases HR, contractility, CO, and BP

26
Q

How are calcium channel blockers used to treat angina?

A

-Vasodilate arterioles to increase blood supply to heart by relaxing smooth muscle
-Decreasing contractility of the heart which reduced oxygen demand

27
Q

What calcium channel blocker exerts a greater effect on the myocardium? Which exerts a greater effect on vascular smooth muscle?

A

-Verapamil: myocardium
-Nifedipine: vascular smooth muscle

28
Q

What are adverse effects of calcium channel blockers?

A

-Constipation
-Reflex tachycardia
-Can worsen HF due to negative inotropic effects (only Verpamil and Diltiazem contraindicated with HF)

29
Q

What is a common sodium channel blocker that is used to treat angina?

A

Ranolazine

30
Q

What is the mechanism of action of sodium channel blockers for the treatment of angina?

A

Inhibits sodium channels which decreases intracellular sodium which decreases AP in heart muscle which decreases oxygen demand of the heart

31
Q

What type of angina is sodium channel blockers indicated for?

A

Stable and chronic angina

32
Q

What are common side effects of sodium channel blockers?

A

-Dizziness
-Headache
-Constipation
-QT interval prolongation

33
Q

What are PT considerations for pt’s taking angina medications?

A

-BP monitoring
-Awareness of angina symptoms
-Exercise prescription
-Recognize side effects
-Patient education

PHTH 561: Pharmacology (5 decks)

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