IHD

Question 1

propanolol

Answer 1

• non-selective B blocker
• decrease HR, contractility, and TPR (afterload)
• chronic use for STABLE ANGINA: 1st line therapy (all B blockers) bc improve survival of pts with recent MI
• use in caution with acute HF pts, diabetes, asthma, PAD, 2nd/3rd AV block (for PAD/diabetes–>use a B1 selective)
• all B blockers equally effective to treat stable angina*

Question 2

nadolol

Answer 2

• non-selective B blocker
• decrease HR, contractility, and TPR (afterload)
• chronic use for STABLE ANGINA: 1st line therapy (all B blockers) bc improve survival of pts with recent MI
• use in caution with acute HF pts, diabetes, asthma, PAD, 2nd/3rd AV block (for PAD/diabetes–>use a B1 selective)

Question 3

acebutolol

Answer 3

• B1 selective blocker
• decrease HR, contractility, and TPR (afterload)
• chronic use for STABLE ANGINA: 1st line therapy (all B blockers) bc improve survival of pts with recent MI; CAN use for PAD/diabetes
• all B blockers equally effective to treat stable angina*

Question 4

metoprolol

Answer 4

• B1 selective blocker
• decrease HR, contractility, and TPR (afterload)
• chronic use for STABLE ANGINA: 1st line therapy (all B blockers) bc improve survival of pts with recent MI; CAN use for PAD/diabetes
• all B blockers equally effective to treat stable angina*

Question 5

nebivolol

Answer 5

• B1 selective blocker
• decrease HR, contractility, and TPR (afterload) (stimulates NO activity)
• chronic use for STABLE ANGINA: 1st line therapy (all B blockers) bc improve survival of pts with recent MI; CAN use for PAD/diabetes
• all B blockers equally effective to treat stable angina*

Question 6

verapamil

Answer 6

-non-DHP calcium channel blocker

• decrease afterload–>decrease wall stress–>decrease O2 demand
• decrease HR and contractility–>decrease O2 demand
• treats pts with stable and prinzmental angina
• contraindicated with pts that have: AV block, bradycardia, HF

Question 7

diltiazem

Answer 7

-non-DHP calcium channel blocker

• decrease afterload–>decrease wall stress–>decrease O2 demand
• decrease HR and contractility–>decrease O2 demand
• treats pts prophylactically with stable and prinzmental angina
• contraindicated with pts that have: AV block, bradycardia, HF

Question 8

amlodipine, nifedipine, any ‘ipine’

Answer 8

• DHP Ca channel blocker
• mainly affect blood vessels–>relax smooth m. of arterioles–> decrease TPR–>decrease afterload and wall stress–>decrease O2 demand
• treats pts prophylactically with stable and prinzmental angina

Question 9

nitroglycerin

Answer 9

-organic nitrate

• metabolized to/releases NO–>dilate epicardial coronary aa–> redistribute blood to ischemic areas
• NO–> dilate veins–> decrease preload–> decrease diastolic wall stress–> decrease O2 demand
• prophylactic stable angina (when B blockers and DHP CCBs not tolerated) or prinzmental angina, and acutely to abort angina attack
• tolerance occurs rapidly, and acutely, can have headache, flushing, orthostatic hypotension, dizziness, reflex tachy (due to vasodilation); drug interaction with sildenafil

Question 10

isosorbide dinitrate

Answer 10

-organic nitrate

• metabolized to/releases NO–>dilate epicardial coronary aa–> redistribute blood to ischemic areas
• NO–> dilate veins–> decrease preload–> decrease diastolic wall stress–> decrease O2 demand
• prophylactic stable angina (when B blockers and DHP CCBs not tolerated) or prinzmental angina, and acutely to abort angina attack
• tolerance occurs rapidly, and acutely, can have headache, flushing, orthostatic hypotension, dizziness, reflex tachy (due to vasodilation); drug interaction with sildenafil

Question 11

isosorbide mononitrate

Answer 11

-organic nitrate

• metabolized to/releases NO–>dilate epicardial coronary aa–> redistribute blood to ischemic areas
• NO–> dilate veins–> decrease preload–> decrease diastolic wall stress–> decrease O2 demand
• prophylactic stable angina (when B blockers and DHP CCBs not tolerated) or prinzmental angina, and acutely to abort angina attack
• tolerance occurs rapidly, and acutely, can have headache, flushing, orthostatic hypotension, dizziness, reflex tachy (due to vasodilation); drug interaction with sildenafil