Exam 5 - Antianginal drugs/Vasodilators Flashcards
What medication(s) are classified as nitrates?
- Nitroglycerin (Nitrostat)
- Isosorbide dinitrate(Isordil)
- Amyl nitrite (isoamylnitrite)
What medication(s) are classified as calcium channel blockers?
- Nifedipine (Procardia)
- Nicardipine (Cardene)
- Amlodipine (Norvasc)
- Verapamil (Isoptin)
- Diltiazem (Cardizem)
What medication(s) are classified as beta blockers?
- Propranolol (Inderal)
- Atenolol (Tenormin)
- Metoprolol (Lopressor)
- Carvedilol (Coreg)
What medication(s) are classified as sodium channel inhibitors?
- Ranolazine (Ranexa)
Nitroglycerin(Nitrostat)
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
Isosorbide dinitrate (Isordil)
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
Amyl nitrite (isoamylnitrite)
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
Nifedipine (Procardia)
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
Nicardipine (Cardene)
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
Amlodipine (Norvasc)
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
Verapamil (Isoptin)
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
Diltiazem (Cardizem)
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
Propranolol (Inderal)
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
Atenolol (Tenormin)
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
Metoprolol (Lopressor)
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
Carvedilol (Coreg)
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
Ranolazine (Ranexa)
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
What type of angina are beta blockers not indicated for?
Variant Angina
What is the MOA of the statins on angina?
Inhibitors of cholesterol synthesis (HMG-COA Reductase Inhibitors)
What is the MOA of the statins on angina?
Inhibitors of cholesterol synthesis
What is the MOA of aspirin on angina?
Inhibits platelet aggregation
Arachidonic acid > COX 1,2,3 > Thromboxane >platelet aggregation
What are specific uses of aspirin beneficial to the CV system?
Antiplatelet Effects
- transient cerebral ischemia (TIA) - unstable angina - MI
Sodium Nitroprusside (Nitropress)
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
Sodium Nitroprusside (Nitropress)
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
Hydralazine (Apresoline)
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
