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CPR Exam 1 > Drugs Used in Stable and Vasospastic Angina > Flashcards

Drugs Used in Stable and Vasospastic Angina Flashcards

1
Q

What are the two ways to approach treating angina pectoris?

A
  • Reduce oxygen demand

- Increase oxygen supply

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2
Q

What are ways to increase coronary blood flow?

A
  • Coronary artery bypass grafting
  • Percutaneous coronary intervention
  • Stent
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3
Q

Can pharmacotherapy be used to increase blood flow through a stenotic coronary artery?

A

NO

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4
Q

What are the drugs in the nitrate drug class?

A
  • Nitroglycerin
  • Isosorbide dinitrate
  • Isosorbide mononitrate
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5
Q

What is the relationship between nitrates and first pass metabolism?

A
  • Nitrates have significant first pass metabolism due to high nitrate reductase activity in liver
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6
Q

How does the liver affect the bioavailability of nitrates? How can this be fixed?

A
  • When taken orally, bioavailability is low but can be fixed by using other routes of administration
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7
Q

Which specific nitrate drug is a poor substrate of nitrate reductase? What is the result of this?

A
  • Isosorbide mononitrate

- Results in increased bioavailability

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8
Q

What is the MOA of nitrates?

A
  • Nitrates form NO which cause venous dilation allowing for a reduced preload. The reduced preload causes a decrease in O2 demand, helping the stable angina
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9
Q

What are some ways someone could become tolerant of nitrate compounds?

A
  • Depletion of thiol compounds
  • Increased superoxide radicals
  • Reflex activation of sympathetic nervous system
  • Retention of salt and water
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10
Q

Which specific drugs are used as short acting drugs? Why?

A
  • Nitroglycerin and isosorbide dinitrate (spray or SL)

- Used to relieve angina attack

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11
Q

Which specific drugs are used as long acting drugs? Why?

A
  • Nitroglycerin, Isosorbide dinitrate, and Isosorbide mononitrate (oral)
  • Used to prevent angina attacks
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12
Q

What are some adverse effects of nitrates?

A
  • Headaches due to meningeal vasodilation (don’t use in intracranial pressure)
  • Orthostatic hypotension
  • Increased sympathetic discharge
  • Increased renal Na+ and H2O reabsorption
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13
Q

What are some drug interactions with nitrates?

A
  • Interacts with drugs used in ED
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14
Q

What are some non-cardioactive calcium channel blockers used to treat stable angina?

A
  • Amlodipine
  • Nifedipine
  • Nicardipine
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15
Q

Which non-cardioactive CCBs is a long acting drug?

A
  • Amlodipine
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16
Q

Which non-cardioactive CCBs are short acting?

A
  • Nifedipine

- Nicardipine

17
Q

What are some cardioactive CCBs used in treating stable angina?

A
  • Diltiazem

- Verapamil

18
Q

What is the MOA of CCBs?

A
  • CCBs block calcium influx in different cell types
19
Q

What cell types does non-cardioactive CCBs affect?

A
  • Vascular smooth muscle
20
Q

What cell types does cardioactive CCBs affect?

A
  • Vascular smooth muscle
  • Cardiac muscle
  • Cardiac pacemaker cells
21
Q

What is the main goal of CCBs in treating stable angina?

A
  • Decrease myocardial O2 demand
22
Q
  • How do CCBs reduce the myocardial O2 demand?
A
  • Dilation of peripheral arterioles
  • Decreased cardiac contractility (cardioactive)
  • Reduced heart rate (cardioactive)
23
Q

What are some major adverse effects of CCBs?

A
  • Cardiac depression, cardiac arrest, and acute heart failure
  • Bradycardia, AV block
  • Severe hypotension
  • Vasodilation triggers reflex sympathetic activation (nicardipine, nifedipine)
  • Nifedipine increases risk of MI in patients with HTN
24
Q

What are some minor adverse effects of CCBs?

A
  • Flushing, headache, anorexia, dizziness
  • Peripheral edema
  • Constipation (verapamil)
25
Q

What are some specific beta blockers that are used to treat stable angina?

A
  • Propranolol
  • Nadolol
  • Metoprolol
  • Atenolol
26
Q

What is the MOA of beta blockers in treating stable angina?

A
  • Decrease HR to improve myocardial perfusion and reduce O2 demand
  • Decrease cardiac contractility
  • Decrease BP leading to reduced afterload
27
Q

What are some adverse effects of beta blockers?

A
  • Reduced cardiac output
  • Bronchoconstriction
  • Impaired liver glucose metabolism
  • Produce unfavorable blood lipoprotein profile (increase VLDL and decrease HDL)
  • Sedation and depression
28
Q

What are some contraindications in using beta blockers for stable angina?

A
  • Asthma
  • Peripheral vascular disease
  • T1 DM on insulin
  • Bradyarrhythmias and AV conduction abnormalities
  • Severe depression of cardiac function
29
Q

What does ranolazine do?

A
  • Inhibits late Na+ current in cardiomyocytes
30
Q

How does ranolazine work in stable angina?

A
  • It normalizes repolarization of cardiac myocytes and reduces mechanical dysfunction
31
Q

What is ranolazine used for?

A
  • Used in which stable angina is refractory to standard medications
  • Decreases angina episode and improves exercise tolerance in patients taking nitrates, amlodipine, or atenolol
32
Q

What is the primary goal of treating vasospastic angina?

A
  • Prevention of episodes
33
Q

What are the first choice drugs in treating vasospastic angina?

A
  • CCBs (diltiazem or amlodipine)
34
Q

What is a second choice therapy if CCBs aren’t indicated in vasospastic angina?

A
  • Long acting nitrates (less desirable due to tolerance)

- Could be added to CCB therapy to increase efficacy

CPR Exam 1 (21 decks)

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