Drugs for Angina Pectoris

Question 1

Principal classes of drugs used for angina pectoris

Answer 1

Nitrates, Beta Blockers, and Calcium Channel Blockers

Question 2

Anginal pain occurs when cardiac oxygen _____________ is insufficient to meet cardiac _____________ demand.

Answer 2

supply; oxygen

Question 3

Cardiac oxygen demand is determined by …………..

Drugs that _____________ these factors can help relieve anginal pain

Answer 3

HR, contractility, preload and afterload

reduce

Question 4

Cardiac oxygen supply is determined by myocardial blood flow. Drugs that _____________ oxygen supply will reduce anginal pain

Answer 4

increase

Question 5

Basically, drugs for angina _____________ the myocardial oxygen demand and _____________ the myocardial oxygen supply

Answer 5

decrease; increase

Question 6

Drugs relieve pain of stable angina by ____________cardiac oxygen demand

Answer 6

decreasing. They do not increase oxygen supply

Question 7

Drugs relieve pain of variant angina by _______________ cardiac oxygen supply

Answer 7

increasing; they do not increase oxygen demand

Question 8

Nitroglycerin and other nitrates are …………….

Answer 8

vasodilators

Question 9

Nitroglycerin relieves pain of stable angina by ____________ veins, which decreases venous return, which __________ preload, which _____________ oxygen demand

Answer 9

dilating; decreases; decreases

Question 10

How does nitroglycerin relieve pain of variant angina?

Answer 10

By relaxing coronary vasospasm, which increases oxygen supply

Question 11

3 characteristic side effects of nitroglycerin

Answer 11

headache
reflex tachycardia
orthostatic hypotension

all 3 occur secondary to vasodilation

Question 12

reflex tachycardia from nitroglycerin can be prevented with

Answer 12

a beta blocker, verapamil or diltiazem

Question 13

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

Answer 13

24; lowest; 8

Question 14

How do beta blockers prevent pain of stable angina ?

Answer 14

Primarily by decreasing the heart rate and contractility, which reduces myocardial oxygen demand

Question 15

Beta blockers are not used for variant angina. True or false

Answer 15

TRUE

Question 16

How do Calcium channel blockers relieve pain of stable angina ?

Answer 16

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)

Question 17

How do Calcium channel blockers relieve pain of variant angina?

Answer 17

By increasing cardiac oxygen supply through relaxation of coronary artery spasm

Question 18

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.

Answer 18

intensify

Question 19

in patients with chronic stable angina, treatment has two objectives

Answer 19

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

Question 20

Cardiac oxygen demand is determined by …………..

Drugs that _____________ these factors can help relieve anginal pain

Answer 20

HR, preload, afterload, contractility

decrease