Exam3 Antianginals- Martin Flashcards
What nitrates do we use to tx angina
nitroglycerin
isosorbide dinitrate
isosorbide dinatrate
what CCBs do we use to Tx angina
verapamil, diltiazem
DHPs: nifedipine, amlodipine, felodipine
what Beta blockers do we use to Tx angina
atenolol, metoprolol, propranolol
what antiplatelets do we use to Tx angina
aspirin, clopidogrel, prasugrel
IIa/IIIb inhibitors: abciximab, tirofiban, eptifibatide
what anticoagulants can we use for angina
heparin, UHF, and LMWH
What drugs do we use for chronic CAD, stable angina
aspirin, Beta antagonists
nitrates, CCBs, ACEI, ranolzine
what drugs do we use for acute coronary syndromes
aspirin, Beta blockers and nitrates
What causes angina
the reversible imbalance between myocardial O2 supply and demand
what increases demand in angina pectoris and what decreases supply
increased demand from increase in HR, increase ventricular contraction and increased wall tension (afterload)
decreased supply from decreased coronary blood flow, O2 carrying capacity of blood or both
What is the sensation of angina
heavy pressing substernal discomfort
radiating left shoulder, flexor aspect of left arm, jaw or epigastrum
signigicant minority of patients describe different location of character
When does typical angina occur
exertional from fixed atherosclerotic narrowing of coronary artery so with increase O2 demand have Sx relieved by rest or NTG last no more than 15 min 5-15 x /week ST segment depression
what is atypical angina
angina at rest
variant, vasospastic, prinzmetals
focul or diffuse coronary vasospasm episodically reduces coronary flow
transient ST elevation during angina
what can cause unstable angina
rupture of atherosclerotic plaque with platelet adhesion and aggregation that decrease coronary blood flow
impending MI
if not relieved by 3 NTG in 15 minutes, call 911
What are the therapeutic approaches to angina
increased O2
decrease O2 demand (decrease work and increase blood flow)
What are the Tx options of choice for typical angina
main goal is to decrease demand
beta blocker and aspirin
beta blocker and aspirin and long acting nitrate
nitrate for subacute (NTG)
ACEI for DM or L ventricular dysfunction
long acting CCBs DHPs or long acting nitrates when beta blocker contraindicated
What are the Tx options for unstable angina
MI so MONA
morphine, O2 NTG, aspirin
usually want beta blocker too
if beta blocker contraindicated use verapamil or dilitiazem if no LV dysfunction
use aspirine and hepatin to decrease thrombus
surgery if needed
thrombolytics “plase”
what is the mechanism of organic nitrates (nitroglycerin)
provide NO
what are the effects of organic nitrates
decrease preload and afterload
relax vascular smooth muscle(large veins which dec VR thus preload)
dilate coronary aa, especiallly subendocardial regions
increase O2 supply (transient)
why is sublingual NTG more effective then direct infusion into heart
vascular effect
what are the routes of admin for NTG
sublingual or spray (PRN) sustained release capsules BID or QID gel 3-5 hr ointment 4-8 hr dermal patch 12-16 hr
what are the routes of admin for isosorbide dintrate
long acting
sublingual Q2-3 hr
oral tablets Q2-3 hr
sustained release tablet Q12 hr
what are the adverse effects of organic nitrates
HA, facial flush, dizziness
orthostatic hypotension (alcohol makes it worse
Tolerance!! dec effectivness with use
dose/frequency dependent
have to give yourself a drug free period. skip certain doses
when are nitrates to be avoided
in acute MI if right ventricular infarction because higher R sided filling Pressures are needed
If patient on viagra! sildenafil, tadalafil, cardenafil
What CCBs have prominent cardiac effects
non DHPs
verapamil and diltizem
