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Pharmacology > Exam 5 - Antianginal drugs/Vasodilators > Flashcards

Exam 5 - Antianginal drugs/Vasodilators Flashcards

1
Q

What medication(s) are classified as nitrates?

A
  1. Nitroglycerin (Nitrostat)
  2. Isosorbide dinitrate(Isordil)
  3. Amyl nitrite (isoamylnitrite)
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2
Q

What medication(s) are classified as calcium channel blockers?

A
  1. Nifedipine (Procardia)
  2. Nicardipine (Cardene)
  3. Amlodipine (Norvasc)
  4. Verapamil (Isoptin)
  5. Diltiazem (Cardizem)
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3
Q

What medication(s) are classified as beta blockers?

A
  1. Propranolol (Inderal)
  2. Atenolol (Tenormin)
  3. Metoprolol (Lopressor)
  4. Carvedilol (Coreg)
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4
Q

What medication(s) are classified as sodium channel inhibitors?

A
  1. Ranolazine (Ranexa)
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5
Q

Nitroglycerin(Nitrostat)

A

Class: Nitrate
MOA: Releases NO in smooth muscle cells> activates guanylyl cyclase and increases cGMP
Effects: smooth muscle relaxation, esp vessels (other smooth m is relaxed but not as much)
Indications: Angina > sublingual form for acute episodes
SE: orthostatic HTN, tachycardia, HA, increases intracranial pressure

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6
Q

Isosorbide dinitrate (Isordil)

A

Class: Nitrates
MOA: Releases NO in smooth muscle cells> activates guanylyl cyclase and increases cGMP
Effects: vasodilation decreases venous return and heart size
Indications: oral/transdermal forms for prophylaxis
SE: orthostatic HTN, tachycardia, HA, increases intracranial pressure

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7
Q

Amyl nitrite (isoamylnitrite)

A

Class: Nitrates
MOA: Releases NO in smooth muscle cells> activates guanylyl cyclase and ^ cGMP
Effects: may increase coronary flow in some areas and variant angina
Indications: IV form for acute coronary syndrome and CHF
SE: orthostatic HTN, tachycardia, HA, ^ intracranial pressure

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8
Q

Nifedipine (Procardia)

A

Class: Calcium Channel Blockers (Dihydropyridines)
MOA: Block vascular L-type calcium channels > cardiac channels
Indications: Prophylaxis of angina, HTN
Effects: Like verapamil and diltiazem, but less cardiac effect
SE: Reflex tachycardia, mild salt and water retention, constipation, flushing, edema and nausea

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9
Q

Nicardipine (Cardene)

A

Class: Calcium Channel Blockers (Dihydropyridines)
MOA: Block vascular L-type calcium channels > cardiac channels
Indications: Prophylaxis of angina, HTN
Effects: Like verapamil and diltiazem, but less cardiac effect
SE: Reflex tachycardia, mild salt and water retention, constipation, flushing, edema and nausea

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10
Q

Amlodipine (Norvasc)

A

Class: Calcium Channel Blockers (Dihydropyridines)
MOA: Block vascular L-type calcium channels > cardiac channels
Indications: Prophylaxis of angina, HTN
Effects: Like verapamil and diltiazem, but less cardiac effect
SE: Reflex tachycardia, mild salt and water retention, constipation, flushing, edema and nausea

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11
Q

Verapamil (Isoptin)

A

Class: Calcium Channel Blockers (Non-Dihydropyridines)
MOA: BlockL-typecalcium channels in vessels and heart
Effects: Reduced vascular resistance, cardiac rate, and cardiac force results in decreased oxygen demand
Indications: Prophylaxis of angina, HTN, Raynaud’s phenomenom
SE: bradycardia, heartblock congestive heart failure

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12
Q

Diltiazem (Cardizem)

A

Class: Calcium Channel Blockers (Non-Dihydropyridines)
MOA: Block L-type calcium channels in vessels and heart
Effects: Reduced vascular resistance, cardiac rate, and cardiac force results in decreased oxygen demand
Indications: Prophylaxis of angina, HTN, Raynaud’s phenomenom
SE: bradycardia, heartblock congestive heart failure

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13
Q

Propranolol (Inderal)

A

Class: Beta-adrenergic Receptor Blockers
MOA: Nonselective β adrenoceptor antagonists. Block β1> β2
Indications: Prophylaxis of angina. *Would NOT be effective in treating vasospastic (variant) angina
Effects: Decreased heart rate, cardiac output, and blood pressure. Decreases myocardial oxygen demand
SE: Bradycardia, heart block, asthma, fatigue, sedation, sleep disturbance (propranolol most profound), dry mouth, nausea and vomiting, constipation and sexual dysfunction

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14
Q

Atenolol (Tenormin)

A

Class: Beta-adrenergic Receptor Blockers
MOA: Nonselective β adrenoceptor antagonists. Block β1> β2
Indications: Prophylaxis of angina. *Would NOT be effective in treating vasospastic (variant) angina
Effects: Decreased heart rate, cardiac output, and blood pressure. Decreases myocardial oxygen demand
SE: Bradycardia, heart block, asthma, fatigue, sedation, sleep disturbance (propranolol most profound), dry mouth, nausea and vomiting, constipation and sexual dysfunction

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15
Q

Metoprolol (Lopressor)

A

Class: Beta-adrenergic Receptor Blockers
MOA: Nonselective β adrenoceptor antagonists. Block β1> β2
Indications: Prophylaxis of angina. *Would NOT be effective in treating vasospastic (variant) angina
Effects: Decreased heart rate, cardiac output, and blood pressure. Decreases myocardial oxygen demand
SE: Bradycardia, heart block, asthma, fatigue, sedation, sleep disturbance (propranolol most profound), dry mouth, nausea and vomiting, constipation and sexual dysfunction

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16
Q

Carvedilol (Coreg)

A

Class: Beta-adrenergic Receptor Blockers
MOA: Nonselective β adrenoceptor antagonists. Block β1> β2
Indications: Prophylaxis of angina. *Would NOT be effective in treating vasospastic (variant) angina
Effects: Decreased heart rate, cardiac output, and blood pressure. Decreases myocardial oxygen demand
SE: Bradycardia, heart block, asthma, fatigue, sedation, sleep disturbance (propranolol most profound), dry mouth, nausea and vomiting, constipation and sexual dysfunction

17
Q

Ranolazine (Ranexa)

A

Class: Sodium Channel Inhibitor
MOA:
1. Sodium channel inhibition
2. Partial inhibition of fatty acid oxidation
3. The most effective drug acts on cell membrane and on the metabolism
Indications: Chronic angina in combination with other antianginal drugs
SE: Dizziness, constipation, headache and nausea
Benefits:
-decreases angina freq
-increases exercise tolerance
-no deleterious effects on hemodynamics
-reduces nitrates dosage

18
Q

What type of angina are beta blockers not indicated for?

A

Variant Angina

19
Q

What is the MOA of the statins on angina?

A

Inhibitors of cholesterol synthesis (HMG-COA Reductase Inhibitors)

20
Q

What is the MOA of the statins on angina?

A

Inhibitors of cholesterol synthesis

21
Q

What is the MOA of aspirin on angina?

A

Inhibits platelet aggregation

Arachidonic acid > COX 1,2,3 > Thromboxane >platelet aggregation

22
Q

What are specific uses of aspirin beneficial to the CV system?

A

Antiplatelet Effects

 - transient cerebral ischemia (TIA)
 - unstable angina
 - MI
23
Q

Sodium Nitroprusside (Nitropress)

A

Class: Arterial/Venous Vasodilator
MOA: Sodium nitroprusside releases NO into smooth muscle tissue > ^ cGMP >  vasodilation (reduces both total peripheral resistance and venous return)
General Concerns: Significant reflex compensatory response in heart function (tachycardia), renin release, and water and salt retention
Indications: CHF, hypertensive emergency
SE: Related to the metabolism of the drug
Sodium nitroprusside  cyanide (released by red blood cells  thiocyanate (liver)
Toxicity of cyanide: excessive hypotension, metabolic acidosis, arrhythmias, and even death
Toxicity of thiocyanate: weakness, disorientation, psychosis, muscle spasms, and convulsions

24
Q

Sodium Nitroprusside (Nitropress)

A

Class: Vasodilator
MOA: Sodium nitroprusside releases NO into smooth muscle tissue > ^ cGMP >  vasodilation (reduces both total peripheral resistance and venous return)
Indications: CHF, hypertensive emergency
SE: Related to the metabolism of the drug
Sodium nitroprusside  cyanide (released by red blood cells  thiocyanate (liver)
Toxicity of cyanide: excessive hypotension, metabolic acidosis, arrhythmias, and even death
Toxicity of thiocyanate: weakness, disorientation, psychosis, muscle spasms, and convulsions

25
Q

Hydralazine (Apresoline)

A

Class: Arterial Vasodilator
MOA: Stimulates nitric oxide (NO) > guanylate cyclase > cGMP pathway
General Concerns:
-Directly act on vascular smooth muscle
-Do not interfere with the ongoing sympathetic tone
-Significant reflex compensatory response in heart function
(tachycardia), renin release, and water and salt retention
Indications: CHF, hypertensive emergency, refractory HTN
SE: Reflex compensatory response:
• CNS: tremor, nausea, headache, palpitations, sweating
• CV: Angina attack and ischemic arrhythmias
• Lupus-like syndromes

Pharmacology (15 decks)

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