Drugs for Angina Pectoris Flashcards
Principal classes of drugs used for angina pectoris
Nitrates, Beta Blockers, and Calcium Channel Blockers
Anginal pain occurs when cardiac oxygen _____________ is insufficient to meet cardiac _____________ demand.
supply; oxygen
Cardiac oxygen demand is determined by …………..
Drugs that _____________ these factors can help relieve anginal pain
HR, contractility, preload and afterload
reduce
Cardiac oxygen supply is determined by myocardial blood flow. Drugs that _____________ oxygen supply will reduce anginal pain
increase
Basically, drugs for angina _____________ the myocardial oxygen demand and _____________ the myocardial oxygen supply
decrease; increase
Drugs relieve pain of stable angina by ____________cardiac oxygen demand
decreasing. They do not increase oxygen supply
Drugs relieve pain of variant angina by _______________ cardiac oxygen supply
increasing; they do not increase oxygen demand
Nitroglycerin and other nitrates are …………….
vasodilators
Nitroglycerin relieves pain of stable angina by ____________ veins, which decreases venous return, which __________ preload, which _____________ oxygen demand
dilating; decreases; decreases
How does nitroglycerin relieve pain of variant angina?
By relaxing coronary vasospasm, which increases oxygen supply
3 characteristic side effects of nitroglycerin
headache
reflex tachycardia
orthostatic hypotension
all 3 occur secondary to vasodilation
reflex tachycardia from nitroglycerin can be prevented with
a beta blocker, verapamil or diltiazem
continuous use of nitroglycerin can produce tolerance within _________ hours. To prevent tolerance, it should be used in ________ effective dosage and long acting formulation should be used on an intermittent schedule that allows at least ____________ drug free hours every day, usually during the night
24; lowest; 8
How do beta blockers prevent pain of stable angina ?
Primarily by decreasing the heart rate and contractility, which reduces myocardial oxygen demand
Beta blockers are not used for variant angina. True or false
TRUE
How do Calcium channel blockers relieve pain of stable angina ?
By reducing cardiac oxygen demand through 2 principles.
All CCB’s relax peripheral arterioles and decrease afterload.
2nd, verapamil and diltiazem reduce heart rate and contractility (in addition to decreasing afterload)
How do Calcium channel blockers relieve pain of variant angina?
By increasing cardiac oxygen supply through relaxation of coronary artery spasm
When a CCB is combined with a beta blocker, a dihydropyridine (nifedipine) is preferred to verapamil or diltiazem. Verapamil or Diltiazem is will ________________cardiosuppression caused by the beta blocker, whereas a dihydropyridine will not.
intensify
in patients with chronic stable angina, treatment has two objectives
1) prevention of MI and death
2) prevention of anginal pain
risk of MI & death can be decreased with 2 types of drugs - antiplatelet agents and cholesterol lowering agents
anginal pain is prevented with one or more long acting antianginal drugs (beta blocker, CCB, long acting nitrate) supplemented with sublingual nitroglycerin when breakthrough pain occurs
Cardiac oxygen demand is determined by …………..
Drugs that _____________ these factors can help relieve anginal pain
HR, preload, afterload, contractility
decrease
