Konorev Drugs for Stable and Vasospastic Angina

Question 1

What are the nitrates?

Answer 1

• Nitroglycerin
• Isosorbide dinitrate
• Isosorbide mononitrate

Question 2

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

Answer 2

• Amlodipine
• Nifedipine
• Nicardipine

Question 3

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

Answer 3

• Diltilazem
• Verapamil

Question 4

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

Answer 4

• Propranolol
• nadolol
• Metoprolol
• atenolol

Question 5

What is stable angina?

Answer 5

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

Question 6

What are three interventional cardiology approaches to stable angina?

Answer 6

• Coronary artery bypass grafting
• Percutaneous coronary intervention
• Stent

Question 7

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

Answer 7

• HR
• Contractility
• Preload
• Afterload

Question 8

All of the following drugs may provoke angina attacks except?

• Isoproterenol
• Ephedrine
• Pilocarpine
• Atropine
• Phentolamie

Answer 8

• Pilocarpine
• A and B are adrenomimtics which increase oxygen demand
• Phentolamine causes refelx tachycardia its an alpha antagonist

Question 9

Describe the pharmacokinetics of Nitrates.

Answer 9

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

Question 10

How do Nitrates work? (NO?)

Answer 10

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

Question 11

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

Answer 11

• Nitrate → NO → Venous dilation → Reduced preload → Decrease O₂ demand

Question 12

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

Answer 12

• Veins > Large arteries> small artery/arterioles

Question 13

How do you develop tolerance to Nitrates?

Answer 13

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

Question 14

What are the clinical uses of nitrates?

Answer 14

• Relieve angina attack
• Prevent attack

Question 15

AE of nitrates?

Answer 15

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

Question 16

What do nitrates interact with?

Answer 16

• Sildenafil
• Vardenafil
• Tadalafil

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

Question 17

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

Answer 17

• 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

Question 18

How do cardioactive CCB’s impact cardiac cells?

Answer 18

• Vascular smooth muscle
• Cardiac muscle
• Cardiac pacemaker cells

Question 19

MOA of CCB’s in stable angina?

Answer 19

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

Question 20

What are the major adverse effects of CCB’s?

Answer 20

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

Question 21

How do Beta blockers work in stable angina?

Answer 21

• Decrease oxygen demand of myocardium

Question 22

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

Answer 22

• slowing of HR
• Diltiazem in cardioactive ccb that slows HR
• Nifedipine will not effect Ca influx

Question 23

What are the beta blockers approved for Stable angina?

Answer 23

• Propranolol
• Nadolol
• Metoprolol
• Atenolol

Question 24

AE’s of Beta blockers

Answer 24

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

Question 25

What is Ranolazine?

Answer 25

* 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

Question 26

Clinical use of Ranolazine?

Answer 26

* Stable angina that is refractory to standard meds * Decrease angina episodes and improves exercise intolerance

Question 27

What is vasospastic angina?

Answer 27

* Episodes of vasoconstriction of coronary arteries

Question 28

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

Answer 28

* CCB's * Diltiazem or amlodipine

Question 29

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

Answer 29

Long acting nitrates

Question 30

Which of the folllowing will cause tachy? Dilitazem Propranolol Nifedipine Cerapamil Ranolazine