Drugs For Angina Pectoris and Heart Failure Flashcards
Portion of the ETC affected by Cyanide
Complex IV (cytochrome oxidase)
Ultra-shortacting nitrate ised as TOC for CYANIDE POISONING
NOT used in angina
Amyl nitrite
May cause methemoglobinemia, reflex tachy and orthostatic hypotension
Antidote for CYANIDE poisoning
Inhaled Amyl Nitrite + IV Sodium nitrite + IV Sodium thiosulfate
Occupational exposure to nitrates causing alternating devt of tolerance during work week and loss of tolerance during weekends
Monday Disease
First-line short-acting Tx for Angina and ACS given via buccal, SL or TD
Works for 4-5mins
Nitroglycerin
SimD: ISDN, ISMN
SE: dangerous hypotension
promotes guanylyl cyclase producing more cGMP resulting to smooth m. Relaxation
Longest half-life among all Short-acting nitrate
ISMN
M for Matagal na halflife
Why does notrate cause throbbing headaches?
Due to meningeal artery vasodilatation
Non-dihydropyrimidine CCB that is used for SVT, vasospasm and RAYNAUD’S PHENOMENON
Diltiazem
Why is Ca-dependent neurotransmission not affected by CCBs?
CCBs block L-type calcium channels
Others uses N-, P- and R- calcium channels
Important effect of nitrates among other drugs for angina
Nitrates alone can inc HR (REFLEX TACHYCARDIA)
Effect of Beta blockers to function of the heart aside from dec HR
Increases ejection time
Two important goals on management of angina
Increasing oxygen delivery
Reducing oxygen requirement
Beta nonselective adrenergic antagonist used for ANGINA PROPHYLAXIS, HPN, arrhythmias and migraine and is CONTRAINDICATED TO ASTHMATICS
Propanolol
SimD: Atenolol, Metoprolol
SE: excessive beta blockade - bronchospasm, AV block, heart failure
Disadvantage of Propanolol
Masks hypoglycemia in diabetic patients and causes ERECTILE DYSFUNCTION
Strategies for CHF
Removal of retained salt and water - DIURETICS
Reduction of afterload and salt and water retention - ACEIs
Reduction of excessive sympathetic stimulation - Beta blockers
Reduction of preload and afterload - VASODILATORS
Direct augmentation of depressed cardiac contractility - POSITIVE INOTROPIC DRUGS
First line Tx for Acute HF
Loop diuretic (FUROSEMIDE)
If very severe, prompt-acting POSITIVE INOTROPES and VASODILATORS
First-line Tx for Chronic HF
Diuretics (loop + spironolactone) + ACEI
And if tolerated, a Beta blocker
EPLERENONE and SPIRONOLACTONE - with signif longterm benefits and dec mortality
Digitalis - used for systolic dysfunction
Which HF presents with orthopnea, PND and pulmonary congestion?
Left-sided HF (pulmo sx)
Which HF presents with hepatomegaly, edema, distended neck veins?
Right-sided HF (systemic sx)
Distended neck veins due to hepatojugular reflux
Cardiac glycoside used in HF and nodal arrhythmias known to have a narrow therapeutic index, causing arrhythmias, diarrhea and VISUAL CHANGES?
Digoxin
Starry starry sky by Van Gogh
Drugs with narrow therapeutic index
WALA na Cyang PaPa! VasTeD na! Warfarin Aminoglycosides Lithium Amphotericin B Carbamazepine Phenobarbital Phenytoin Vancomycin Theophylline Digoxin
SE of Digoxin on electrolytes
Inc Ca, Dec K and Mg
Hypokalemia - aggrav by K loss in Thiazide and loop diuretic use
Hypomagnesemia - aggrav by Mg loss in digitalis-induced vomiting
TOC for arrhythmia sec to Digitalis toxicity
Lidocaine
Other tx for dig-tox Digoxin Ab (Fab fragments, Digibind)
Advantages of Angiotensin antagonists
ARBs and ACEIs
Reduces aldosterone secretion resulting to lower salt and water retention
Reduces vascular resistance
Reduces mortality and morbidity in CHF
MAIN ADV: DEC VENTRICULAR REMODELLING (CARDIOPROTECTIVE)
Prevents stretching of myocardium and infil of Connective tis.
MAIN ADVANTAGE OF ANGIOTENSIN ANTAGONIST
ARBs have same BENEFITS as ACEIs
DEC VENTRICULAR REMODELLING (CARDIOPROTECTIVE)
Beta1-selective sympathomimmetic useful in acute HF
Dobutamine
D1 agonist: Dopamine
Not appropriate for CHF due to tolerance and lack of oral efficacy and significant arrhythmogenic effects
Beta blockers that are used in CHF to reduce progression of the dse
Carvedilol, LABetalol and Metoprolol
However, NOT of value in acute HF and SHOULD NOT BE USED in systolic dysfunction
MOA of phosphodiesterase inhibitors
Ex. Inamrinone, Milrinone
Inc cAMP by inhib breakdown by phosphodiesterase, inc intracellular Ca -> VASODILATION
SHOULD NOT BE USED IN CHF bec they inc morb and mort.
Vasodilator used for acute severe HF with congestion
Also effective in CHF
Nitropusside or Nitroglycerin
Hydralazine and ISDN - reduces mort in African-Americans
CCBs - of no value in CHF
What drugs have been shown to improve survival in cases of HF?
ABA! Buhay ka pa!
ACE Inihibitors
Beta blockers
Aldosterone antagonists
