Drugs For Angina Pectoris and Heart Failure

Question 0

Portion of the ETC affected by Cyanide

Answer 0

Complex IV (cytochrome oxidase)

Question 1

Ultra-shortacting nitrate ised as TOC for CYANIDE POISONING

NOT used in angina

Answer 1

Amyl nitrite

May cause methemoglobinemia, reflex tachy and orthostatic hypotension

Question 2

Antidote for CYANIDE poisoning

Answer 2

Inhaled Amyl Nitrite + IV Sodium nitrite + IV Sodium thiosulfate

Question 3

Occupational exposure to nitrates causing alternating devt of tolerance during work week and loss of tolerance during weekends

Answer 3

Monday Disease

Question 4

First-line short-acting Tx for Angina and ACS given via buccal, SL or TD

Works for 4-5mins

Answer 4

Nitroglycerin
SimD: ISDN, ISMN

SE: dangerous hypotension

promotes guanylyl cyclase producing more cGMP resulting to smooth m. Relaxation

Question 5

Longest half-life among all Short-acting nitrate

Answer 5

ISMN

M for Matagal na halflife

Question 6

Why does notrate cause throbbing headaches?

Answer 6

Due to meningeal artery vasodilatation

Question 7

Non-dihydropyrimidine CCB that is used for SVT, vasospasm and RAYNAUD’S PHENOMENON

Answer 7

Diltiazem

Question 8

Why is Ca-dependent neurotransmission not affected by CCBs?

Answer 8

CCBs block L-type calcium channels

Others uses N-, P- and R- calcium channels

Question 9

Important effect of nitrates among other drugs for angina

Answer 9

Nitrates alone can inc HR (REFLEX TACHYCARDIA)

Question 10

Effect of Beta blockers to function of the heart aside from dec HR

Answer 10

Increases ejection time

Question 11

Two important goals on management of angina

Answer 11

Increasing oxygen delivery

Reducing oxygen requirement

Question 12

Beta nonselective adrenergic antagonist used for ANGINA PROPHYLAXIS, HPN, arrhythmias and migraine and is CONTRAINDICATED TO ASTHMATICS

Answer 12

Propanolol
SimD: Atenolol, Metoprolol

SE: excessive beta blockade - bronchospasm, AV block, heart failure

Question 13

Disadvantage of Propanolol

Answer 13

Masks hypoglycemia in diabetic patients and causes ERECTILE DYSFUNCTION

Question 14

Strategies for CHF

Answer 14

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

Question 15

First line Tx for Acute HF

Answer 15

Loop diuretic (FUROSEMIDE)

If very severe, prompt-acting POSITIVE INOTROPES and VASODILATORS

Question 16

First-line Tx for Chronic HF

Answer 16

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

Question 17

Which HF presents with orthopnea, PND and pulmonary congestion?

Answer 17

Left-sided HF (pulmo sx)

Question 18

Which HF presents with hepatomegaly, edema, distended neck veins?

Answer 18

Right-sided HF (systemic sx)

Distended neck veins due to hepatojugular reflux

Question 19

Cardiac glycoside used in HF and nodal arrhythmias known to have a narrow therapeutic index, causing arrhythmias, diarrhea and VISUAL CHANGES?

Answer 19

Digoxin

Starry starry sky by Van Gogh

Question 20

Drugs with narrow therapeutic index

Answer 20

WALA na Cyang PaPa! VasTeD na!
Warfarin
Aminoglycosides
Lithium
Amphotericin B
Carbamazepine
Phenobarbital
Phenytoin
Vancomycin
Theophylline
Digoxin

Question 21

SE of Digoxin on electrolytes

Answer 21

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

Question 22

TOC for arrhythmia sec to Digitalis toxicity

Answer 22

Lidocaine

Other tx for dig-tox
Digoxin Ab (Fab fragments, Digibind)

Question 23

Advantages of Angiotensin antagonists

ARBs and ACEIs

Answer 23

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.

Question 24

MAIN ADVANTAGE OF ANGIOTENSIN ANTAGONIST

ARBs have same BENEFITS as ACEIs

Answer 24

DEC VENTRICULAR REMODELLING (CARDIOPROTECTIVE)

Question 25

Beta1-selective sympathomimmetic useful in acute HF

Answer 25

Dobutamine

D1 agonist: Dopamine

Not appropriate for CHF due to tolerance and lack of oral efficacy and significant arrhythmogenic effects

Question 26

Beta blockers that are used in CHF to reduce progression of the dse

Answer 26

Carvedilol, LABetalol and Metoprolol

However, NOT of value in acute HF and SHOULD NOT BE USED in systolic dysfunction

Question 27

MOA of phosphodiesterase inhibitors

Answer 27

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.

Question 28

Vasodilator used for acute severe HF with congestion

Also effective in CHF

Answer 28

Nitropusside or Nitroglycerin

Hydralazine and ISDN - reduces mort in African-Americans
CCBs - of no value in CHF

Question 29

What drugs have been shown to improve survival in cases of HF?

Answer 29

ABA! Buhay ka pa!
ACE Inihibitors
Beta blockers
Aldosterone antagonists