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stuff > Lecture 2 Anti-anginal Drugs > Flashcards

Lecture 2 Anti-anginal Drugs Flashcards

1
Q

Anginal Pectoris (pain)

A

Oxygen demand exceeds oxygen supply

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2
Q

Agents decreasing Oxygen demand

A

a) Beta-blockers
b) Calcium-channel blockers (non-dihydropyridine kinds)
c) Organic Nitrates
d) Calcium Channel Blockers

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3
Q

Agents increasing oxygen supply

A

a) Vasodilators
b) Statins
c) Anti-thrombotics

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4
Q

What affects Cardiac Wall Tension?

A

LV pressure and Ventricular Volume (diastolic pressure and volume)

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5
Q

Why is increased wall tension bad?

A

Cardiomyocytes work more = Inc’d Oxygen Demand

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6
Q

How does niphedipine affect aortic pressure?

A

lowers pressure gradient which can cause angina

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7
Q

What is needed for Coronary Blood Flow?

A

Coronary Vascular Resistance & Aortic Pressure

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8
Q

Pressure gradient role in Coronary Blood Flow?

A

No gradient = no coronary blood flow

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9
Q

Exertional Angina cause?

A

Increased Oxygen Demand

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10
Q

Treatment for Exertional Angina

A

a) Nitrates
b) Beta-blockers
c) Calcium Channel Blockers

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11
Q

Variant (vasospastic) Angina Cause (no exertion)

A

Dec’d Oxygen Supply

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12
Q

Vasospastic Angina Treatment

A

a) Nitrates
b) CCB (70% cured, 20% reduction)

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13
Q

Unstable Angina Cause

A

Plaque interferes w/ coronary arteries (fibrous cap) –> clotting and blockage

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14
Q

Unstable Angina Treatment

A

a) Nitrates
b) Beta Blockers
c) CCB
d) Aspirin (NSAID, Anti-platelet)
e) Clopidogrel (ADP antagonist, Anti-platelet)
f) Heparin (anti-coagulant)
g) Bypass Surgery/ Angioplasty

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15
Q

What is Contraindicated in Vasoplastic Angina

A

Beta Blockers

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16
Q

Standard of Card for Nitroglycerin

A

IV

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17
Q

Function of Phosphodiesterase-5? (PDE-5)

A

Convert cGMP to GMP

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18
Q

What does NO do?

A

make Guanylyl Cyclase (converts GRP to cGMP)

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19
Q

What does Sildenafil do?

A

Inhibits PDE-5 inducing relaxation

20
Q

Nitrates + Sildenafil Cause?

A

Hypotension

21
Q

Where do Organic Nitrates work?

A

Peripheral Veins (Venous Circulation)

22
Q

Function of Organic Nitrates

A

Cleaves nitrates on venous side –> increases venous capacity –> Lowers Left Venous Diastolic pressure & volume –> Dec’s wall tension

23
Q

what kind of hypotension can organic nitrates cause

A

Orthostatic Hypotension

24
Q

Why are organic nitrates not given orally?

A

Avoid First pass effect

25
Q

Extra info: Enzymes on the venous side that work to release NO which then stimulates guanylate cyclase to induce relaxation

A

…

26
Q

Why cant you take a lot of organic nitrates

A

Builds Tolerance, caused by decrease in TISSUE SULYHYDRYL GROUPS

27
Q

True/False: Tolerance develops for Calcium Channel Blockers

A

False

28
Q

First choice for Vasospastic Angina

A

Organic Nitrates + CCB

29
Q

What is second choice for PREVENTION of exertional angina?

A

Organic Nitrates (long acting, Patches/transdermal)

30
Q

What are short acting standby drugs given to patients with coronary artery disease?

A

GTN, ISDN

31
Q

Adverse effects of Organic Nitrates

A

Headache, Dizziness, Orthostatic HYPOtension, syncope (fainting)

32
Q

nitrates decrease platelet aggregation (T/F)

A

True

33
Q

NO-mediated vasodilation of large vessels causes what?

A

preload reduction –> inc’d collateral blood flow to ischemic myocardium

34
Q

5 beta blockers used for Angina Pectoris

A

Atenolol, Metoprolol, Nadolol, Propranolol, Timolol

35
Q

First choice for preventions of EXERTIONAL and UNSTABLE angina

A

Beta blockers

36
Q

Beta blocker effect on myocardial oxygen consumption?

A

Decreases it by increasing diastolic perfusion time

37
Q

Beta blocker adverse effects

A

bradycardia, AV block, bronchospasm, peripheral constriction, worsening of acute heart failure, depression

38
Q

Extra Info: Polymorphic CYP2D6 Metabolism (Metoprolol)

A

Additional Vasodilation (Carvedilol,nebivolol)

39
Q

Treatment of Stable Ischemic Heart Disease

A

1) Sublingual Nitroglycerin for immediate relief
2) Beta blocker (If vasospastic dont give)
3) CCB or Long acting Nitrate (IF 1 & 2 inadequate)
4) Ranolazine (If 3 inadequate)

40
Q

Function of Ranolazine

A

reduced intracellular [Ca2+] reducing cardiac contraction and work

41
Q

what can be used as a substitute for beta blockers for patients with contraindication?

A

Ranolazine

42
Q

Non-dihydropyridines

A

Verapamil, Diltiazem

43
Q

Suffix “-pine”

A

CCB

44
Q

What do Calcium Channel Blockers work on?

A

SA and AV node, cardiac myocytes, coronary arteries and peripheral arterioles

45
Q

What type of channels do CCBs block?

A

L-Type (long living)

46
Q
A

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