Exam 1: Lecture 11, Angina

Question 1

3 Types of angina

Answer 1

Stable
Unstable
Variant

Question 2

3 classes of drugs for angina

Answer 2

Organic nitrates
Calcium channel blockers
Beta blockers

Question 3

Nitrates: Prototype

Answer 3

Nitroglycerin

Question 4

Nitrates: MOA

Answer 4

Increase cGMP which decreases Ca that mediates contraction and dephosphorylates MLC’s leading to relaxation

Question 5

Nitrates: Applications

Answer 5

Angina, acute coronary syndrome

Question 6

Nitrates: notables

Answer 6

Undergoes large first pass effect, given sublingually to avoid

Tachyphylaxis - tolerance; decrease effect of same drug dose given repeatedly, so have to give it time

Interaction with sildenafil, don’t take together…space by 6 hours

Question 7

Which types of Angina can nitrates be used for?

Answer 7

Stable

Variant/Vasospastic/Prinzmetal’s

Unstable

Question 8

Beta-blockers: Prototype

Answer 8

Propranolol

Question 9

Beta-blockers: MOA

Answer 9

Competitive inhibitors of Ne and EPi at B1 (cardiac) and B2 (smooth muscle/lung) receptors, inhibit renin release

Question 10

Beta-blockers: Applications

Answer 10

Angina, hypertension, arrhythmias, migraine, performance anxiety

Question 11

How many generations of Beta-blcokers?

Answer 11

3

1st = non-selective
2nd = B1 selective
3rd = Vasodilatory

Question 12

Which types of Angina can Beta-blockers be used for?

Answer 12

Stable (mainly used here)

Unstable

Question 13

Beta-blockers notables

Answer 13

By using drugs that block B2 receptors, it leaves the vasoconstricting alpha receptors unopposed and potentially making angina worse

Have to be weened off, ~ 3 weeks

Question 14

Beta-blockers contraindicated in….

Answer 14

Asthma

Variant Angina

bronchospasm

AV/SA node dysfunction

Question 15

Ca Channel blockers: prototype

Answer 15

Verapamil (nondihydropyridine)

Nifedipine (dihydropyridine)

Question 16

Ca Channel blockers: MOA

Answer 16

Inhibition of L-type calcium channels,

Blocks calcium channels in the SR

Question 17

Ca Channel blockers: Applications

Answer 17

Angina, hypertension, supraventricular tachyarrhythmias

Question 18

Ca Channel blockers: notables

Answer 18

High 1st past effect,

High Albumin binding = cause for Drug-Drug interactions

Extensive metabolism, due to CYP450

Question 19

Which types of Angina can Ca Channel-blockers be used for?

Answer 19

Stable

Variant/Vasospastic/Prinzmetals

unstable if pt refractory for other 2

Question 20

MONA

Answer 20

Morphine, Oxygen, Nitroglycerin, Aspirin = treatment of Angina in ER

Question 21

Monday disease and Nitrate tolerance

Answer 21

Those working in chemical plants or who get exposed to nitrates develop a tolerance during the week, then lose some of it over the weekend. When they return to work on Monday the exposure to nitrates can make them feel bad, but they regain tolerance and are better following days

Question 22

Drugs to treat stable Angina

Answer 22

Nitrates, Ca Channel blockers, Beta-blockers

Question 23

Drugs to treat Variant Angina

Answer 23

Nitrates, Calcium channel blockers

Question 24

Drugs to treat Unstable Angina

Answer 24

Acute coronary syndrome must be treated with (anti platelets, aspirin, clopidogrel, heparin) plus nitrates and Beta-blockers

For refractory disease, calcium channel blockers used.

Question 25

Most effective calcium channel blocker?

Answer 25

Verapamil in all aspects…ie Vasodilation, decreasing cardiac contractility, etc

Question 26

Reperfusion

Answer 26

is when you have reoxygenation, when you reoxyenate it can trigger cell death by activating mPTP

Question 27

Importance of Foam Cells

Answer 27

Macrophages that turn into these foam cells from collecting ApoB proteins. will then cause a build of of ApoB-Lp, instead of digesting them.

foam cells = responsible for formation of plaques

Question 28

What happens when foam cells die?

Answer 28

Apoptosis, then all the stuff in the cell will build up and a necrotic core will form. This fibrous cap is weakened, then thrombus comes and binds to ruptured region and will lead to blocked vasculature

This is due to efferocytosis not being able to occur (clean up)

Question 29

raynauds syndrome

Answer 29

cold sensitivity and poor circulation to extremities due to limited coruscation

usually in women

Question 30

Vasospastic/Prinzmetals Angina

Answer 30

increase vasoconstriction and decrease vasodilation

Question 31

drugs increasing oxygen delivery?

Answer 31

Nitrates and Calcium channel blockers

Question 32

Drugs decreasing oxygen demand?

Answer 32

Nitrates/beta blockers/calcium channel blockers

Question 33

Beta blockers will..

Answer 33

decrease heart rate, blood pressure and contractility

which decrease oxygen requirements at rest and exercise (effecting oxygen demand)

Question 34

Main focus of beta blockeres

Answer 34

B1 receptor in cardiac cell…

Beta-blockers will reduce ca moving into the cell/ and from SR

B2 mediate vasodilation

Question 35

Why beta-blockers not used in spastic angina/asthma?

Answer 35

By blocking beta receptors in vasculature, you’ll have more alpha receptors open which cause vasoconstriction

Question 36

Ranolazine

Answer 36

Not common in angina, but used in patients who don’t respond to other options

MOA: blocks Late sodium channel, preventing Na/ca exchange and decreases contraction

Question 37

Aspirin

Answer 37

Rational = anti platelet activity

COX1 inhibitor, it prevents cascade involved in platelet aggregation

given to patients with unstable angina