Drugs Used in Angina Pectoris Flashcards
Therapeutic Strategies in Angina
increase oxygen delivery – VASODILATION
decrease oxygen requirement – DECREASING THE HEART RATE
Releases NO, increases cGMP and relaxed smooth muscle
Nitrates
Due to occupational exposure to nitrates
Monday Disease
- alternating devt during the work week and loss of tolerance (over the weekend) every Monday
DOC for Prinzmetal Angina
Diltiazem
Treatment for Methemoglobinemia caused by nitrites
Low dose Methylene Blue
Beta Blockers and Nitrates
OPPOSITE effects on heart size, force, venous tone, and heart rate
B Blockers and Calcium Channel Blockers
SAME effects on heart size, force and rate
Reduces a late prolonged Na current in myocardial cells – decreased intracellular Na – increase Ca – expulsion via NaCa2+ exchanger – decrease intracellular Ca2+ – decrease cardiac force and work
Ranolazine
Inhibits beta oxidation of FA by inhibiting 3 ketoacyl-CoA thiolase w/ enhances glucose oxidation
Trimetazidine
Selective If channel blocker - decreases hyperpolarization-inruced inward pacemaker current – decrease HR and cardiac work
Ivabradine
A 57-year-old woman presents to her primary care
physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within
the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin.
- Which of the following is a common direct or reflex effect of nitroglycerin?
(A) Decreased heart rate (B) Decreased venous capacitance (C) Increased afterload (D) Increased cardiac force (E) Increased diastolic myocardial fiber tension
(D) Increased cardiac force
INCREASES heart rate and venous capacitance
DECREASES afterload and diastolic fiber tension
increases cardiac contractile force because the decrease in blood pressure evokes a compensatory increase in sympathetic discharge
In advising the patient about the adverse effects she may notice, you point out that nitroglycerin in moderate doses often produces certain symptoms. Which of the following effects might occur due to the mechanism listed?
(A) Constipation due to reduced colonic activity
(B) Dizziness due to reduced cardiac force of contraction
(C) Diuresis due to sympathetic discharge
(D) Headache due to meningeal vasodilation
(E) Hypertension due to reflex tachycardia
(D) Headache due to meningeal vasodilation
One year later, the patient returns complaining that her nitroglycerin works well when she takes it for an acute attack but that she is now having more frequent attacks and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort include
(A) Amyl nitrite (B) Esmolol (C) Sublingual isosorbide dinitrate (D) Sublingual nitroglycerin (E) Verapamil
(E) Verapamil
If a β blocker were to be used for prophylaxis in this patient, what is the most probable mechanism of action in angina?
(A) Block of exercise-induced tachycardia
(B) Decreased end-diastolic ventricular volume
(C) Increased double product
(D) Increased cardiac force
(E) Decreased ventricular ejection time
(A) Block of exercise-induced tachycardia
A new 60-year-old patient presents to the medical clinic with hypertension and angina. He is 1.8 meters tall with a waist measurement of 1.1 m. Weight is 97 kg, blood pressure is 150/95, and pulse is 85. In considering adverse effects of possible drugs for these conditions, you note that an adverse effect that nitroglycerin and prazosin have in common is
(A) Bradycardia (B) Impaired sexual function (C) Lupus erythematosus syndrome (D) Orthostatic hypotension (E) Weight gain
(D) Orthostatic hypotension
A 25-year-old man is admitted to the emergency department with a brownish cyanotic appearance, marked shortness of breath, and hypotension. He has needle marks in both arms. Which of the following is most likely to cause methemoglobinemia?
(A) Amyl nitrite (B) Isosorbide dinitrate (C) Isosorbide mononitrate (D) Nitroglycerin (E) Sodium cyanide
(A) Amyl nitrite
Another patient is admitted to the emergency department after a drug overdose. He is noted to have hypotension and severe bradycardia. He has been receiving therapy for hypertension and angina. Which of the following drugs in high doses causes bradycardia?
(A) Amlodipine (B) Isosorbide dinitrate (C) Nitroglycerin (D) Prazosin (E) Verapamil
(E) Verapamil
A 45-year-old woman with hyperlipidemia and frequent migraine headaches develops angina of effort. Which of the following is relatively contraindicated because of her migraines?
(A) Amlodipine (B) Diltiazem (C) Metoprolol (D) Nitroglycerin (E) Verapamil
(D) Nitroglycerin
When nitrates are used in combination with other drugs for the treatment of angina, which one of the following combinations results in additive effects on the variable specified?
(A) Beta blockers and nitrates on end-diastolic cardiac size
(B) Beta blockers and nitrates on heart rate
(C) Beta blockers and nitrates on venous tone
(D) Calcium channel blockers and β blockers on cardiac force
(E) Calcium channel blockers and nitrates on heart rate
(D) Calcium channel blockers and β blockers on cardiac force
Certain drugs can cause severe hypotension when combined with nitrates. Which of the following interacts with nitroglycerin by inhibiting the metabolism of cGMP?
(A) Atenolol (B) Hydralazine (C) Isosorbide mononitrate (D) Nifedipine (E) Ranolazine (F) Sildenafil (G) Terbutaline
(F) Sildenafil
Lilly Cyanide Kit
inhaled amyl nitrite
IV sodium nitrite
IV sodium thiosulfate
Ultrashort Acting Nitrates
Amyl Nitrite
Nitroglycerin
Isosorbide dinitrate (ISDN) Isosorbide mononitrate (ISMN)
(-) beta oxidation of fatty acid by (-) 3-ketoacyl-CoA thiolase which enhances glucose oxidation
Interacts with MAO (-)
Trimetazidine
