Drugs used in angina pectoris

Question 1

Modifiable risk factors for coronary artery disease

Answer 1

HTN
HLD
DM
Cigarette smoking
Obesity

Question 2

Non-modifiable risk factors of coronary artery disease

Answer 2

Age
Male gender
Race
Family history

Question 3

Burning, squeezing, or crushing CP that may radiate to L arm, shoulder, or jaw. Generally occurs after physical exertion. ECG may show ST segment depression

Answer 3

Angina pectoris

Question 4

Unstable angina

Answer 4

CP during rest that may progress to MI

Question 5

ECG findings in Prinzmetal/vasospastic angina

Answer 5

ST segment elevation

Question 6

Class I angina pectoris

Answer 6

CP after strenuous activity

Question 7

Class II angina pectoris

Answer 7

CP after walking >2 blocks or climbing 1 flight of stairs

Question 8

Class III angina pectoris

Answer 8

CP when walking 1-2 blocks or climbing 1 flight of stairs

Question 9

Class IV angina pectoris

Answer 9

CP at rest

Question 10

Stable angina

Answer 10

CP occurs with exercise or stress and is relieved by rest

Question 11

Goals of angina treatment

Answer 11

Increase blood/oxygen supply by decreasing vasospasm
Decrease blood/oxygen demand by decreasing TPR and/or CO

Question 12

Agents that can activate endothelial NO synthase (nitrites)

Answer 12

Acetylcholine
Histamine
Bradykinin
Serotonin

Question 13

Mechanism of NO in vessels

Answer 13

Increases cGMP to cause vasodilation by dephosphorylating myosin light-chain to prevent its interaction with actin

Question 14

How nitrites decrease cardiac oxygen demand

Answer 14

Dilation of large veins to decrease preload and decrease cardiac work

Question 15

How nitrites increase cardiac oxygen supply

Answer 15

Arteriolar dilation leading to decreased afterload (high doses)

Question 16

Cardiovascular benefits of nitrites

Answer 16

Decrease cardiac oxygen demand
Increase cardiac oxygen supply
Improve collateral blood flow
Decrease coronary vasospasm
Inhibit platelet aggregation

Question 17

Nitrites used clinically for angina pectoris

Answer 17

Nitroglycerin
Isosorbide (XR)
Amyl nitrite
Sodium nitrite

Question 18

Side effects of nitrities

Answer 18

HA
Flushing
Syncope
Reflex tachycardia
Edema
Tachyphylaxis

Question 19

Specific adverse effect associated with amyl nitrite and its treatment

Answer 19

Methemoglobinemia –> methylene blue

Question 20

Specific adverse effect associated with amyl nitrite and sodium nitrite and its prevention

Answer 20

Cyanide poisoning
Administer with sodium thiosulfate and/or vit B12

Question 21

Drugs interaction of nitrities

Answer 21

PDE5 inhibitors –> severe hypotension

Question 22

Affect of beta blockers in angina pectoris

Answer 22

Decrease force of contraction, HR, and CO –> overall decrease in oxygen demand

Question 23

Contraindication of beta blockers for angina

Answer 23

Prinzmetal angina –> keep alpha-1 open causing vasospasm

Question 24

Only anti-anginal drug class proven to increase survival post MI

Answer 24

Beta blockers

Question 25

Ca channel blocker only used for angina and why it is not approved for use in US.

Answer 25

Bepridil
Risk of Torsades de Pointes

Question 26

Mechanism of Bepridil

Answer 26

Dilates coronary arteries by blocking Na and K channels

Question 27

Ca channel blockers used in angina pectoris

Answer 27

Dihydropyridines –> Amlodipine and nifedipine

Non-dihydropyridines –> Verapamil and dilitiazem

Question 28

Metabolic modifier that blocks late inward Na current used in angina pectoris. No affect on BP or HR.

Answer 28

Ranolazine

Question 29

Contraindication of ranolazine

Answer 29

Class I and class III antiarrhythmic drugs –> prolong QT interval

Question 30

Used for angina in CHF pts with LVEF <35%. Used in pts who cannot tolerate beta blockers.

Answer 30

Ivabradine

Question 31

Mechanism of ivabradine

Answer 31

Decreases HR by blocking funny channel (IF current)

Question 32

Side effects of ivabradine

Answer 32

Bradycardia –> AV block
Luminous phenomena –> IF channel in retina