Drugs for Coronary Artery Disease

Question 1

Nitroglycerin

1) Use
2) Mechanism of Action

Answer 1

1) Decrease coronary vascular resistance
2) Nitrovasodilator- converts to NO which increases cGMP, preventing interaction of myosin and actin causing relaxation of vascular smooth muscle
* Short-acting d/t 1st pass metabolism*

Question 2

Isosorbide dinitrate

1) Use
2) Mechanism of Action

Answer 2

1) Decrease coronary vascular resistance
2) Nitrovasodilator- converts to NO which increases cGMP, preventing interaction of myosin and actin causing relaxation of vascular smooth muscle

Question 3

Isosorbide mononitrate

1) Use
2) Mechanism of Action

Answer 3

1) Decrease coronary vascular resistance
2) Nitrovasodilator- converts to NO which increases cGMP, preventing interaction of myosin and actin causing relaxation of vascular smooth muscle
* Long-acting*

Question 4

What are the side effects of Nitrates?

Answer 4

Nitrate Tolerance-decreased response and tachyphylaxis

HA, HypoTN, Reflex tachycardia

Question 5

What medication is contraindicated with Nitrates?

Answer 5

Phosphodiesterase Type 5 Inhibitors (PDE-5 inhibitors)

Question 6

Sildenafil

1) Use
2) Mechanism of Action

Answer 6

1) Erectile Dysfunction and Primary Pulmonary HTN
2) Phosphodiesterase 5 Inhibitor-prevents breakdown of cGMP causing increased cGMP levels preventing interaction of myosin and actin causing relaxation of vascular smooth muscle

Question 7

Vardenafil

1) Use
2) Mechanism of Action

Answer 7

1) Erectile Dysfunction
2) Phosphodiesterase 5 Inhibitor-prevents breakdown of cGMP causing increased cGMP levels preventing interaction of myosin and actin causing relaxation of vascular smooth muscle

Question 8

Avanafil

1) Use
2) Mechanism of Action

Answer 8

1) Erectile Dysfunction
2) Phosphodiesterase 5 Inhibitor-prevents breakdown of cGMP causing increased cGMP levels preventing interaction of myosin and actin causing relaxation of vascular smooth muscle
* Quick onset*

Question 9

Tadalafil

1) Use
2) Mechanism of Action

Answer 9

1) Erectile Dysfunction
2) Phosphodiesterase 5 Inhibitor-prevents breakdown of cGMP causing increased cGMP levels preventing interaction of myosin and actin causing relaxation of vascular smooth muscle
* LONG-acting-“Weekend Drug”*

Question 10

Name PDE-5 Inhibitor Side Effects

Answer 10

HA, Ototoxic, blurred vision

HypoTN when combined w/Nitrates and/or alpha blockers

Question 11

Diltiazem

1) Use
2) Mechanism of Action

Answer 11

1) Chronic coronary heart disease, HTN, SVT

2) Calcium Channel Blocker-blocks voltage dependent (L-type) Ca2+ channels-Cardiac selective

Question 12

Verapamil

1) Use
2) Mechanism of Action

Answer 12

1) Chronic coronary heart disease, HTN, SVT

2) Calcium Channel Blocker-blocks voltage dependent (L-type) Ca2+ channels-Cardiac selective

Question 13

Nifedipine

1) Use
2) Mechanism of Action

Answer 13

1) Vasospasm- Prinzmetal angina and Cerebral hemorrhage, Chronic coronary heart disease, HTN, SVT
2) Calcium Channel Blocker-blocks voltage dependent (L-type) Ca2+ channels-Vascular selective

Question 14

Amlodipine

1) Use
2) Mechanism of Action

Answer 14

1) Vasospasm- Prinzmetal angina and Cerebral hemorrhage, Chronic coronary heart disease, HTN, SVT
2) Calcium Channel Blocker-blocks voltage dependent (L-type) Ca2+ channels-Vascular selective

Question 15

Nicardipine

1) Use
2) Mechanism of Action

Answer 15

1) Vasospasm- Prinzmetal angina and Cerebral hemorrhage, Chronic coronary heart disease, HTN, SVT
2) Calcium Channel Blocker-blocks voltage dependent (L-type) Ca2+ channels-Vascular selective

Question 16

Name Ca2+ Channel Blocker side effects.

Answer 16

Prolonged QT/V-Tach/Bradycardia, HA
Heart Failure (Verapamil)
Peripheral Edema (Vascular selective drugs)

Question 17

Ca2+ Channel Blockers are contraindicated in what type of patients?

Answer 17

Heart Failure patients d/t negative inotropic effects

Question 18

Nimodipine

1) Use
2) Mechanism of Action

Answer 18

1) Vasospasm- Prinzmetal angina and Cerebral hemorrhage, Chronic coronary heart disease, HTN, SVT
2) Calcium Channel Blocker-blocks voltage dependent (L-type) Ca2+ channels-Vascular selective

Question 19

Acebutolol

1) Use
2) Mechanism of Action

Answer 19

1) Coronary heart disease W/OUT Heart Failure

2) Selective Beta-1 Blocker- Cardiac Selective-Decreased HR and contractility

Question 20

Atenolol

1) Use
2) Mechanism of Action

Answer 20

1) Coronary heart disease W/OUT Heart Failure

2) Selective Beta-1 Blocker- Cardiac Selective-Decreased HR and contractility

Question 21

Metoprolol

1) Use
2) Mechanism of Action

Answer 21

1) Coronary heart disease W/OUT Heart Failure

2) Selective Beta-1 Blocker- Cardiac Selective-Decreased HR and contractility

Question 22

Propranolol

1) Use
2) Mechanism of Action

Answer 22

1) Coronary heart disease W/OUT Heart Failure

2) Non-selective Beta Blocker- blocks Beta 1 and 2 receptors

Question 23

Name adverse effects of Beta Blockers

Answer 23

Bronchospasm, Hypoglycemia, Myocardial depression, Rebound HTN w/abrupt discontinuation

Question 24

When would Beta Blockers be contraindicated?

Answer 24

Asthma, AV Block, Severe PVD, Prinzmetal Angina

Question 25

Ranolazine

1) Use
2) Mechanism of Action

Answer 25

1) Chronic Angina, Diastolic Dysfunction
2) Inhibits late Na+ (aka funny) channels which decreases Na+ and Ca2+ in myocytes
* Minimal effects on HR/BP*

Question 26

Ranolazine is contraindicated in patients with ___ and ___.

Answer 26

Prolonged QTs

Hepatic impairment