Exam 2: Antianginal Drugs Flashcards
How is Prinzmetals angina treated?
Nitrates and CCBs
O2 demand depends on cardiac workload, which is determined by what 3 things?
- HR
- Myocardial contractility
- Ventricular wall tension
Any increase in HR or contractility increases the need for ***.
O2
What 3 things decrease coronary flow?
1) shortening diastole when HR increases
2) increased ventricular end-diastolic pressure
3) reduced diastolic arterial pressure
What are the 2 nitrates/nitrites?
Nitroglycerin and isosorbide dinitrate
What is the MOA of Nitrates/Nitrites?
Uneven vasodilation via NO and cGMP pathway.
Large veins are markedly dilated. Arterioles and precapillry sphincters are less dilated
What is the DOC for any acute angina attack?
Nitrates/nitrites
How do nitrates cause anginal relief?
Decreases myocardial O2 requirement
Why is the sublingual route for nitrates preferred?
It is the fasting acting, and it avoids hepatic destruction
Slow release Nifedipine is indicated only in ** and not in **.
Why?
Indicted in HTN, not angina.
It may provoke angina pectoris
What are the beneficial effects of The Dihydropyridines?
Vasodilation leading to increased myocardial O2 supply and decreased afterload
What are the harmful effects of Dihydropyridines?
Rapid hypotension leading to baroreflex activation causing increased cardiac workload and ischemia
What are the beneficial effects of diltiazem and verapamil?
Decreased myocardial contractility.
Bradycardia caused by decreased SA node automaticity and AV node conduction
What are the harmful effects of Verapamil and diltiazem?
Potential to cause serious cardiac depression that could end in cardiac arrest, AV block, or HF
How do B-blockers provide anginal relief?
Decreased sympathetic activation, leading to decreased cardiac activity and decreased vasoconstriction. Hypotension and bradycardia then cause decreased cardiac workload and decreased Myocardial O2 demand
