medications for angina

Question 1

vasodilators used for angina

Answer 1

nitrates and calcium blockers

Question 2

types of nitrates for angina

Answer 2

long duration (transdermal nitroglycerin)
intermediate (oral nitro)
short duration (sublingual nitro)

Question 3

cardiac depressants

Answer 3

calcium blockers and beta blockers

Question 4

preload

Answer 4

filling pressure of the heart, dependent on venous tone and blood volume, determines end diastolic fiber length and tension
-controlled by sympathetic outflow

Question 5

afterload

Answer 5

impedance to ejection of stroke volume
determined by arterial blood pressure and arterial stiffness
determines systolic fiber length
-systolic determinants of oxygen requirement

Question 6

monday disease

Answer 6

industrial disease caused by chronic exposure to vasodilating concentrations of organic nitrates in the workplace.
-Characterized by dizziness, headaches, and tachycardia on return to work after 2 days absence

Question 7

MOA of nitrates

Answer 7

nitrates release NO within smooth muscle cells
-stimulates guanylyl cyclase and causes an increase of second messenger cGMP-> causes relaxation by dephosphorylation of myosin light-chain phosphate

Question 8

nitrates cause

Answer 8

• venodilation-> reduced cardiac size and cardiac output through reduced preload
• relaxation of arterial smooth muscle, may reduce afterload

Question 9

calcium channel blockers MOA

Answer 9

• block voltage-gated L-type calcium channels ( the ones most important to cardiac and smooth muscle)
• reduce intracellular calcium concentrations and muscle contractility

Question 10

short acting nitrate

Answer 10

nitroglycerin sublingual
-releases NO increases cGMP and relaxes vascular smooth muscle
-acute angina
-rapid: 1 min
-dur. 15 min
SE: tachycardia, orthostatic hypotension, headache

Question 11

intermediate acting nitrate

Answer 11

oral nitroglycerin 
- like nitro SL
-active nitrate dinitroglycerin 
-prophylaxis of angina
slower onset, dur 2-4 hours
SE: tachycardia, orthostatic hypotension, headache

Question 12

long acting nitrate

Answer 12

transdermal nitro
-MOA same as nitro SL
-prophylaxis for angina
-slow onset
long duration of absorption: 24 hours, effects: 10 hr
SE: tachycardia, orthostatic hypotension, headache

Question 13

ultra-short acting nitrate

Answer 13

amyl nitrate
MOA same as nitro SL
-obsolete

Question 14

calcium channel blockers

Answer 14

verapamil
diltiazem
nifedipine
almodipine, felodipine, nicardipine, nisoldipine (like nifedipine)

Question 15

verapamil

Answer 15

blocks L-type Ca channel in smooth muscle and heart

• decreases intracellular Ca
• treats: angina (both atherosclerotic, vasospastic), HTN, AV nodal arrhythmias, migraine
• oral or IV
• dur. 6-8 hr
• SE: constipation, pretibial edema, flushing, dizziness, higher doses for cardiac depression, hypotension

Question 16

nifedipine

Answer 16

dihydropyridine Ca channel blocker, vascular >cardiac effect

• treats: angina, HTN
• oral, slow release from duration
• SE: constipation, pretibial edema, flushing, dizziness, higher doses for cardiac depression, hypotension

Question 17

beta blockers

Answer 17

propranolol

• blocks sympathetic effects on heart and blood pressure
• reduces renin release
• treat: angina, HTN, arrhythmias, migraine, performance anxiety
• oral, IV
• dur. 6 hr

Question 18

antianginal drugs

Answer 18

ranolazine

ivabradine

Question 19

ranolazine

Answer 19

blocks late Na current in myocardium, reduces cardiac work
-treats: angina
-oral
-dur. 10-12hr
SE: prolongation on ECG, inhibits CYP3A and 2D6

Question 20

Ivabradine

Answer 20

blocks pacemaker Na current (If) in SA node, reduces HR

-angina, heart failure