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CPR 2 Exam 1 > Konorev Drugs for Stable and Vasospastic Angina > Flashcards

Konorev Drugs for Stable and Vasospastic Angina Flashcards

1
Q

What are the nitrates?

A
  • Nitroglycerin
  • Isosorbide dinitrate
  • Isosorbide mononitrate
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2
Q

What are the non cardioactive calcium channel blockers used in stable/vasospastic angina?

A
  • Amlodipine
  • Nifedipine
  • Nicardipine
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3
Q

What are the cardioactive Ca channel blockers used in stable/vasospastic angina?

A
  • Diltilazem
  • Verapamil
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4
Q

What are the beta blockers used for stable/vasospastic angina?

A
  • Propranolol
  • nadolol
  • Metoprolol
  • atenolol
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5
Q

What is stable angina?

A
  • Occlusion of coronary arteries from atherosclerotic plaques
  • Most common form
  • Sx occur during stress
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6
Q

What are three interventional cardiology approaches to stable angina?

A
  • Coronary artery bypass grafting
  • Percutaneous coronary intervention
  • Stent
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7
Q

What are the determinates of myocardial oxygen demand that need to be reduced to help treat stable angina?

A
  • HR
  • Contractility
  • Preload
  • Afterload
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8
Q

All of the following drugs may provoke angina attacks except?

  • Isoproterenol
  • Ephedrine
  • Pilocarpine
  • Atropine
  • Phentolamie
A
  • Pilocarpine
  • A and B are adrenomimtics which increase oxygen demand
  • Phentolamine causes refelx tachycardia its an alpha antagonist
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9
Q

Describe the pharmacokinetics of Nitrates.

A
  • They have significant first pass metabolism
    • using sublingual/patch/spray increases bioavailability
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10
Q

How do Nitrates work? (NO?)

A

They release NO and it diffuses to smooth muslces cells activity guanyl cyclase releasing GMP causing K channels to open and smooth mm to relax

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11
Q

Describe the MOA of nitrates in stable angina. (how do we get to a decreased oxygen demand?)

A
  • Nitrate → NO → Venous dilation → Reduced preload → Decrease O2 demand
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12
Q

Order the Sensitivities of vasculature to nitrate induced vasodilation. ( veins, large artery, small artery arteriols)

A
  • Veins > Large arteries> small artery/arterioles
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13
Q

How do you develop tolerance to Nitrates?

A
  • Depletion of thiol compounds
  • Increase generation of superoxide radicals
  • Reflex activation of sympathetic nervous system
  • Retention of salt and water
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14
Q

What are the clinical uses of nitrates?

A
  • Relieve angina attack
  • Prevent attack
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15
Q

AE of nitrates?

A
  • HA due to meningeal vasodilation
  • Orthostatic hypotension
  • Increased sympathetics
  • Increase Na and water reabsorption
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16
Q

What do nitrates interact with?

A
  • Sildenafil
  • Vardenafil
  • Tadalafil

These are ED drugs, interaction can lead to a severe drop in BP and increase in cGMP

17
Q

55 yo male diagnosed with exertional angina was prescribed sublingual nitroglycerin. Which of the following molecular actions most likely mediates the therapeutic efficacy of this drug in his disease?

  • Increase intracellular Ca concentration
  • Increase synthesis of guanylyl cyclase
  • Increase production of N20
  • Activation of myosin light chain kinase
  • Activation of protein kinase G
A
  • NO released as result of metabolic activity of nitroglycerin, will activate soluble guanylyl cyclase to make cGMP.
  • This will activate pKG to dilate venule smooth muscle
  • Activation of protein kinase G
18
Q

How do cardioactive CCB’s impact cardiac cells?

A
  • Vascular smooth muscle
  • Cardiac muscle
  • Cardiac pacemaker cells
19
Q

MOA of CCB’s in stable angina?

A
  • Decrease Oxygen demand by decreasing:
    • peripheral arterioles
    • Cardiac contractility
    • Reduced heart rate
20
Q

What are the major adverse effects of CCB’s?

A
  • Cardiac depression, arrest, and acute HF
  • Bradycardia & AV block
  • Severe hypotension
  • Nifedipine increases risk of MI in patients wit HTN
21
Q

How do Beta blockers work in stable angina?

A
  • Decrease oxygen demand of myocardium
22
Q

Which of the following will be the most likely effect of dilitazem but not nifedipine?

  • slow HR
  • Hyperpolarization of SA node
  • Short RR interval
  • Reduced PVR and BP
  • Relax vascular sm mm
A
  • slowing of HR
  • Diltiazem in cardioactive ccb that slows HR
  • Nifedipine will not effect Ca influx
23
Q

What are the beta blockers approved for Stable angina?

A
  • Propranolol
  • Nadolol
  • Metoprolol
  • Atenolol
24
Q

AE’s of Beta blockers

A
  • Reduce CO
  • Bronchoconstriction
  • Impaired glucose mobilization of liver
  • Produces unfavorable Lipoprotein profile
  • Sedation and depression
  • Withdrawl sx
25
Q

What is Ranolazine?

A
  • Inhibit late Na current in cardiomyocytes
  • It normalizes repolarization of cardiac myocytes and reduces mechanical dysfunction
    • may decrease diastolic tension and compression of coronary vessels and cardiac contractility and O2 demand
26
Q

Clinical use of Ranolazine?

A
  • Stable angina that is refractory to standard meds
  • Decrease angina episodes and improves exercise intolerance
27
Q

What is vasospastic angina?

A
  • Episodes of vasoconstriction of coronary arteries
28
Q

What is the first choice of drugs to treat vasospastic angina?

A
  • CCB’s
    • Diltiazem or amlodipine
29
Q

If CCB’s are contraindicated in a patient with vasospastic angina, what is used?

A

Long acting nitrates

30
Q

Which of the folllowing will cause tachy?

Dilitazem

Propranolol

Nifedipine

Cerapamil

Ranolazine

A

CPR 2 Exam 1 (21 decks)

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