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Block 9 Week 1 > Duan-Antianginal drugs > Flashcards

Duan-Antianginal drugs Flashcards

1
Q

What are the three major protoype drugs for angina?

A
  • nitrates
  • B-blockers
  • Calcium Channel blockers
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2
Q

What is the most common organic nitrate?

A

Nitroglycerin

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3
Q

What is the most common B-adrenoreceptor antagonist?

A

propranolol (inderal)

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4
Q

What are the most common calcium channel blockers?

A

Nifedipine (procardia)
Verapamil (isopin)
Diltiazem (cardizem)

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5
Q

(blank) is an acute coronary syndrome with episodic chest pains as a result of transient coronary ischemia (as opposed to myocardial infarction where a coronary artery is acutely and completely occluded).
What is the pain due to?
Why does it occur?

A

Angina Pectoris

  • Inadequate metabolic supply
  • when blood supply to heart is limited due to disruption of coronary blood flow, increased demand for oxygen, or a combo of both
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6
Q

What are the clinical symptoms of angina pectoris?

A

1) Chest pain or discomfort;
2) Pain in arms, neck, jaw, shoulder or back;
3) Nausea;
4) Fatigue;
5) Shortness of breath;
6) Sweating;
7) Dizziness

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7
Q 
What can this cause:
exposure to cold
emotional stress
medicines that constrict BV
smoking
cocaine use
A

acute vasospasm occuring at rest or sleep

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8
Q

What is the most common type of angina? How long does it last? Can you relieve this?

A

stable angina
less than 5 minutes
rest or medicine.

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9
Q

What is this:
occurs at rest or sleeping or with little physical exertion
comes as a surprise
last up to 30 minutes

Can you relieve this with rest or medicine?
What can this lead to?

A

unstable angina
No
can lead to an MI

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10
Q

What is the goal of alleviating angina?

A

increasing O2 supply and decreasing O2 demand

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11
Q

How do you increase coronary blood flow?

increases O2 supply

A
  • nitrates
  • calcium channel blockers (CCB)
  • Stents
  • Angioplasty
  • Bypass
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12
Q

How do you increase regional myocardial blood flow?

increases O2 supply

A
  • nitrates
  • CCBs
  • Beta blockers
  • Statins (chronic)
  • Aspirin (chronic)
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13
Q

How do you decrease heart rate?

A

CCBs

Beta Blockers

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14
Q

How do you decrease contractile force on the heart to decrease O2 demand?

A

CCBs

Beta blockers

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15
Q

How do nitrates work?

A

improve blood flow by relaxing and dilating veins and arteries, including the coronary arteries, by increase nitric oxide in SMC of BVs
->

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16
Q

What does this:

dilation of peripheral capacitance and resistance vessels

A

nitroglycerin

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17
Q

How can you decrease preload (venous) to decrease O2 demand?

A

nitrates

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18
Q

How can you decrease afterload (PVR) to decrease O2 demand?

A

Nitrates

CCBs

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19
Q

Since NG will dilate capacitance vessels, what will this result in?
It will also dilate resistance vessels, what will this result in?

A
  • pooling of blood in veins-> decreased venous return-> decreased preload.
  • decrease peripheral vascular resistance (PVR)-> decreases afterload and increase O2 supply.
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20
Q

Are NG’s lipid or water soluble? How do you administer it? What organ metabolizes it? When is the onset of action?

A

lipid soluble
sublingual
liver
30 seconds

21
Q

What are the adverse effects of NG?

A

headache, postural hypotension, methemoglobinemia

22
Q

Repeated exposure to organic nitrates may be accompanied by development of (bank) to their vasodilatory actions

A

tolerance (called the mondays at munitions factories)

23
Q

What are some other organic nitrates other than NG?

A

Amyl nitrate
Isosorbide dinitrate
Erythrityl tetranitrate
Pentaerythritol tetranitrate

24
Q

What nitrate is this:
Dilates resistance vessels

What nitrate is this:
long acting nitrates

What nitrate is this:
chronic stable angina pectoris, prophylaxis of angina pain. Explosive and must be diluted with something like lactose

What nitrate is this:
the nitrate ester of pentaerythritol, and is structurally very similiar to nitroglycerin, one of the most powerful high explosives

A

Amyl nitrate

Isosorbide dinitrate

Erythrityl tetranitrate

Pentaerythritol tetranitrate

25
Q

What is the onset of action of a sublingual NG tablet? What is the duration of action?

A

1-3 minutes

30-60 minutes

26
Q

What is the prophylactic tx of angina that is particularly frequent and unpredictable?

A

Beta-blockers

27
Q

How do Beta blockers affect heart rate and contractile force? What does this lead to?

How do Beta blockers affect BP? What does this lead to?

How do beta blockers affect regional myocardial blood flow? What does this lead to?

A

decrease HR, decrease contractile force–> decrease O2 demand -> increase excercise tolerance

decrease BP-> decrease afterload-> decrease O2 demand

Increase regional myocordial blood flow-> increase O2 supply

28
Q

What are common Calcium Channel Blockers (CCBs)?

A

Nifedipine (procardia)
Verapamil (isopin, calan)
Diltiazem (generic, Cardizem)

29
Q

What are the effects of CCBs? What types of angina do you use this for?

A

vasodilate-> decrease BP-> decrease Afterload-> decrease O2 demand

Decrease HR and decrease contractile force-> decrease O2 demands

“classical” angina and “variant” angina

30
Q

CCBs are extremely potent coronary vasodilators-> increased coronary and regional myocardial blood flow-> increased O2 supply so a good treatment for (blank) angina

A

variant

31
Q

What is Ranolazine and what is it used for?

A

a sodium current inhibitor in cardiac myocytes-> reduces intracellular calcium-> reduced O2 demand (since you dont need to contract as much you wont need to use a bunch of oxygen to make this happen) AND reduces calcium overload
AND
is a fatty acid oxidation inhibitor that shifts ATP production to more oxygen efficient carb oxidation

Used for chronic angina!
(also can be used in neuropathic pain)

32
Q

How does calcium overload happen and why is this bad?

A

Ischemia causes loss of Na-K grandient causing loss of ability to regulate Ca. Calcium then floods into the cell. MItochondria sucks up all the calcium and loses ability to do oxidative phosphorylation-> activates phospholipases and protein kinases-> causes membrane damage and creates leukotrienes and thromboxane
->profound tissue irritants which can cause platelet aggregation, clotting, vasospasm, and edema

33
Q

How will nitrates affect HR?
How will BB or CBBs affect HR?
How will they combined affect HR?

A

Increase
Decrease
Decrease

34
Q

How will nitrates affect Arterial pressure?
How will BB or CBBs affect Arterial pressure?
How will they combined affect Arterial pressure?

A

decrease
decrease
decrease

35
Q

How will nitrates affect end diastolic volume?
How will BB or CBBs affect end diastolic volume?
How will they combined affect end diastolic volume?

A

decrease
increase
none or decrease

36
Q

How will nitrates affect contractility?
How will BB or CBBs affect contractility?
How will they combined affect contractility?

A

increase
decrease
none

37
Q

How will nitrates affect Ejection time?
How will BB or CBBs affect Ejection time?
How will they combined affect Ejection time?

A

decrease
increase
none

38
Q

What are calcium channel blockers best for?

A

variant angina

39
Q

What are b-adrenergic antagonists best for?

A

MI

40
Q

What is aspirin best for?

A

unstable angina, and MI

41
Q

What is fibrinolytic drugs best used for?

A

MI

42
Q

What works pretty good for stable, unstable and variant angina and MI?

A

Organic nitrite and nitrates

43
Q

What can you use to treat variant angina?

A

organic nitrite and nitrates

Calcium channel blockers

44
Q

What cant you use to treat MI?

A

CCBs

45
Q

What can you use to treat unstable and stable angina?

A

fibrinolytic drugs

46
Q

What are these able to treat:
ACE inhibitors, oral antiplatelet medicines, or anticoagulants (blood thinners).
How?

A

angina

  • Lower blood pressure and -cholesterol levels
  • Slow the heart rate
  • Dilate blood vessels
  • Prevent blood clots from forming
47
Q

(blank) can help prevent episodes of angina: Slow down or take rest breaks if physical exertion triggers angina. Avoid large meals and rich foods if heavy meals trigger angina. Try to avoid upset or stressed situations if emotional stress triggers angina etc.

A

Lifestyle changes

48
Q

If lifestyle changes and medicines don’t control angina, a medical procedure may be needed to treat the underlying heart disease. Both (blank) and (blank) are commonly used to treat patients with typical angina.

A

angioplasty

coronary artery bypass grafting (CABG)

Block 9 Week 1 (7 decks)

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