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CRAAB 5 > Nordgren: Anti-anginal drugs > Flashcards

Nordgren: Anti-anginal drugs Flashcards

1
Q

What drugs are traditionally used as anti-anginals?

A
  1. Organic nitrates
  2. Ca channel blockers
  3. β-Adrenoceptor Antagonists (Blockers)
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2
Q

Why do we use anti-anginal drugs?

A
  1. They all decrease myocardial 02 demand!

2. They can increase 02 supply to ischemic tissues

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3
Q

What happens when you decrease myocardial 02 demand?

A 
It leads to a decrease in:
HR
ventricular volume
bp
contractility
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4
Q

What may someone who’s been on a nitrate for a long time encounter?

A

They may develop a tolerance to the drug.

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5
Q

What drugs cause venodilation more than arterial dilation?

A

Nitrates

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6
Q

What does venodilation do?

A

Decreases:

  1. preload (VFP)
  2. pulmonary vascular resistance
  3. decreased pulmonary left ventricular end-diastolic pressure
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7
Q

Why might you see a slight decrease in TPVR and slight increase in HR at higher doses of nitrates?

A

A decrease in left ventricular end diastolic pressure (decreased SV) triggers baroreceptors and results in an increase in HR and an increase in contractility.

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8
Q

If you give someone a nitrate, how does this affect the distribution of blood flow?

A

A nitrate doesn’t change the total coronary blood flow but it does decrease left ventricular end-diastolic volume and pressure, leading to REDISTRIBUTION of blood to the ENDOCARDIUM.

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9
Q

What will giving someone a nitrate do overall in terms of supply and demand?

A
  1. It will decrease left ventricular end diastolic pressure (supply) which will in turn decrease the preload (demand).
  2. A decrease in pressure triggers baroreceptors to increase HR and contractility at high doses.
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10
Q

What is the MOA of nitroglycerine?

A

Releases NO in smooth muscle>
activates guanyl cylase>
increase cGMP

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11
Q

What are the pathophysiological reasons for giving a patient nitro?

A 
NO>
smooth muscle relaxation>
decreases venous return>
decrease in heart size>
increase coronary flow in some areas
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12
Q

What do you use nitroglycerine for and what are the different ways to give it?

A

Angina

  1. Acute episodes- sublingual
  2. prophylaxis- oral and transdermal
  3. ACS- IV
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13
Q

What is the negative of giving someone an oral dose of nitro?

A

Nitroglycerine has a HIGH FIRST PASS METABOLISM so an oral dose of nitro must be much bigger than a sublingual one.

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14
Q

Why might reflex tachycardia, and headache be observed when you’ve given a pt nitro?

A

Nitro can lead to a decrease in pressure which triggers baroreceptors and can increase HR leading to reflex tachycardia.

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15
Q

What drugs do you want to avoid if you’re taking nitroglycerine?

A

Phosphodiesterase type 5 inhibitors (viagra, cialis, levitra)

They can cause synergistic HYPOTENSION.

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16
Q

Why would you give someone isosorbide dinitrate over nitroglyercine?

A

slightly LONGER duration of action

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17
Q

What is isosorbide mononitrate used for?

A

It’s an active metabolite of dinitrate that’s used for prophylaxis.

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18
Q

How would you give a pt a Ca channel blocker?

A

Orally

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19
Q

How does a Ca channel blocker increase the supply of oxygenated blood to the heart?

A
  1. Smth muscle relaxation> Increase total coronary blood flow> decreases aortic diastolic P
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20
Q

How does a Ca channel blocker decrease the demand for O2 of the heart?

A
  1. Decreases heart rate

2. decreases contractility

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21
Q

What is the MOA of verapamil and diltiazem?

A

NONSELECTIVE block of L type Ca channels in VESSELS and HEART

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22
Q

What are the pathophysiologic effects of Ca blockers?

A

Reduce:
vascular resistance

Decreased contractility and conductivity of the heart–>
DECREASED 02 demand

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23
Q

What do you use Ca channel blockers for?

A

Prophylaxis of angina

Hypertension

24
Q

What must you be careful of when you’re giving a pt verapamil or diltiazem?

A

AV block, or acute heart failure

They are also additive with other cardiac depressants and hypotensive drugs

25
Q

What is nifedipine?

A

Dihydropyridine

26
Q

What is the MOA of Nifedipine?

A

Blocks vascular L type Ca channels > cardiac channels

27
Q

How does nifedipine differ from other ca blockers like verapamil and diltiazem?

A

Less cardiac effect

28
Q

What do you use nifedipine for?

A

Prophylaxis of angina and hypertension just like the other Ca blockers

29
Q

What must you be concerned about when giving a pt nifedipine?

A

Excessive hypotension, barorecpetor reflex tachycardia

It can be additive with other vasodilators

30
Q

How to beta blockers decrease myocardial 02 demands?

A

Decrease HR> decrease contractility> decrease bp

31
Q

How is a lower heart rate linked to diastolic perfusion time?

A

Lower heart rate>
increase in diastolic perfusion time>
increase coronary perfusion

32
Q

What’s drug may help to treat silent angina?

A

Beta blockers

33
Q

What drug is proven to decrease mortality in patients with recent MI and improve survival and prevent stroke in patients with hypertension?

A

Beta blockers

34
Q

What drug should you NOT give to pts with asthma, bradycardia, AV block or unstable left ventricular failure?

A

Beta blockers

35
Q

How do Beta blockers decrease myocardial consumption of 02?

A

Decrease HR>
decreased contractility>
decreased 02 demand

36
Q

How do betablockers increase the supply of of 02 for myocardial consumption?

A

They DECREASE aortic diastolic pressure.

37
Q

How might beta blocker negatively affect the supply of 02 for the myocardium?

A

Overall decrease in coronary blood flow.

Increase in coronary artery resistance

Increase in left ventricular end diastolic P.

38
Q

What is the MOA for propanolol?

A

Noselective competitive antagonist at Beta adrenoceptors

39
Q

What does proanolol do?

A

Decrease HR–> decreased force of contraction–> decreased AV conduction–> decreased BP–> decreased in MYO demand

40
Q

What do you use propranolol for?

A

prophylaxis of angina

41
Q

What do you have to be watch out for when giving a pt propanolol?

A

asthma, AV block, acute heart failure

It is also additive with all cardiac depressants.

42
Q

What are atenolol and metroprolol?

A

B1 selective blockers–> less risk of bronchospasm

43
Q

What is a common direct or reflex effect of nitroglycerin?

A

increased cardiac force

44
Q

What drug often causes tachycardia?

A

isosorbide nitrate

45
Q

What drugs are vasodilators?

A

Nitrates

Calcium blockers

46
Q

What drugs are cardiac depressants?

A

calcium blockers

beta blockers

47
Q

What drugs cause a reflex increase in heart rate?

A

Nitrates

48
Q

What drugs decrease heart rate?

A

beta blockers

calcium channel blockers

49
Q

What drugs decrease arterial pressure?

A

nitrates
beta blockers
ca channel blockers

50
Q

What drugs increase EDV?

A

Beta blockers

Ca channel blockers

51
Q

What drug decreases EDV?

A

Nitrates

52
Q

What drug leads to a reflex increase in contractility?

A

Nitrates

53
Q

What drug decreases contractility?

A

Beta blockers

Ca blockers

54
Q

What drugs decrease ejection time?

A

Nitrates

55
Q

What drugs increase ejection time?

A

beta blockers

ca channel blockers

CRAAB 5 (9 decks)

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