pharm: 10-15 Antianginal drugs Flashcards
A: Name the 2 Determinants of Coronary Perfusion
B: Explain how the Sympathetic System causes Net Vasodilation in Coronary Arteries
- Diastolic Perfusion Pressure (Aortic Diastolic pressure - EDP)
- Coronary Vascular Resistance (compression and intrinsic regulation)
B: During INC Myocardial work, Neural Sympathetic Regulation causes some vasoconstriction but also INC Myocardial work more —> INC local metabolites —> Net VasoDilation Effect
Tx for [Stable Exertional Angina] (6)
– Nitrates (also used to tx vasospastic angina)
– Calcium Channel Blockers
– Beta Blockers
– Ranolazine
– Catheter-based techniques (Percutaneous Catheterization Interventions such as balloon angioplasty)
– CABG
A: [T or F] Nitric Oxide mechanism depends on endothelium to be processed
B: 4 Systemic Effects of Organic Nitrates
A: FALSE! Relaxation by NO is Endothelium-INDEPENDENT!
B:
- DEC VENOUS RETURN by Dilating Venous Capacitance Vessels
- DEC LV WALL TENSION
- DEC AFTERLOAD (arteriolar vasodilator)
- DIRECT CORONARY ARTERY VASODILATATION (Increased Subendocardial Perfusion)
A: Clinical Use of Organic Nitrates (5)
B: Side Effects (5)
A:
- Angina Pectoris (Exertional,Unstable, Variant)
- Hypertensive Emergencies
- CHF
- Tx and Px of Exercise-induced myocardial ischemia
- Coronary Artery Vasospasm
B: SE
a) Orthostatic Hypotension
b) Reflex Tachycardia
c) Headache
d) Nitrate Tolerance (high doses of long acting nitrates)
e) Methemoglobinemia
A:[Ca+ Channel Blockers are potent ______] but have no effect on _______.
B: How do [Ca+ channel blockers] CARDIAC muscle (3)
A: [Ca+ Channel Blockers are potent Arteriolar VasoDilators] but have no effect on venous. They do this by affecting Ca+ entry into smooth m.
B: In Cardiac: they are
- Negative inotropic agents
- Decrease rate of SA node Phase 4 depolarization —> [DEC heart rate]
- Slow AV nodal conduction velocity
A: Clinical Use of Calcium Channel Blockers (6)
B: Which [Ca+ Channel Blocker] is longg acting? Is it Dihydropyridine or [NON-Dihydropyridine]?
C: List the order from MOST [Negative Inotrope and Negative Chronotrope] to least
D: List order from MOST VasoDilatory to least
HARHAM!
- Angina (All 3 )
- HTN
- Arrhythmias
- Hypertrophic Cardiomyopathy
- Migraine
- Raynaud’s Phenomenon (vasospasm of feet and hands when exposed to cold air)
B: Amlodpine = Long Acting Dihydropyridine
C: Verapamil > Diltiazem > nifedipine
D: “Never Dilate Vessels”
[Nifedipine > Diltiazem > verapamil]
Adverse Effects of [Dihydropyridine Ca+ Channel Blocker] (3)
a) Reflex Tachycardia
b) Peripheral Edema
c) Hypotension
A: Lusitropy
B: What causes this?
C: What is the INC Rate of Conduction referred to as?
A; INC Rate of Relaxation by the [Sarcoplasmic Reticulum]
B: cAMP (when activated by Beta 1 sympathetic stimulation in heart)
C: Dromotropy (note: Chronotropy= INC Pacemaker Current)
Beta Blockers
Indications (8)
“Beta blockers HAMMED my HP”
- Exertional Angina
- HTN
- Arrhythmias
- Dissecting Aortic Aneurysm
- Mitral Valve Prolapse
- Post-MI prophylaxis
- Hyperthyroidism
- Migraine
Beta Blockers
- A: Lipid or Water Soluble*
- B: Which are ONLY eliminated by Renal? (3)*
- C: Which are ONLY eliminated by Liver? (3)*
A: Lipid Soluble
B: RANS - Renal= Atenolol/Nadolol/Sotalol
C: Liver = Propranolol / Carvedilol / Metoprolol “PCM”
A: What is Ranolazine and what does it do?
B: How does the heart generate ATP
C: During acute MI, ⬜ rise precipitously, and inhibit ⬜—> glucose oxidation is ______ which is undesirable when O2 supply is limited in MI
D: Net Result of using this drug (3)
E: Indication and Side Effect
A: [pFOX inhibitor] inhibits mitochondrial enzymes of beta oxidation which relieves inhibition on pyruvate dehydrogenase.–> allowing heart to use more glucose as a fuel during MI
B: Under normal conditions the heart can use either glucose or fatty acids to generate ATP.
C: During acute MI, fatty acids rise precipitously, and inhibit pyruvate dehydrogenase.—>glucose oxidation is depressed which is undesirable when O2 supply is limited in MI
D: The net result is
- reduced lactic acid accumulation,
- less intracellular acidosis
- reduction in severity of MI
E: [1st line - Exertional Angina] (espeically in those w/angina despite other therapy) but causes [Prolonged AP duration]
Name the 3 Drugs that [INC time of Angina onset and [ST segment depression]] in pts with exertional angina
- Diltiazem (Ca+ channel blockers)
- Metoprolol (Beta blockers)
- Nitrates
4 CNS Adverse Effects of Beta Blockers
- Insomnia
- Depression
- Fatigue
- Raynaud’s Phenomenon (cold extremities)
Major Adverse Effects of [Nifedipine Non-Dihydropyrdine Ca+ channel Blocker] (3)
– Reflex Tachycardia
– Peripheral Edema
– Hypotension
Niseritide
- A: Indication (2)*
- B: MOA (2)*
- C: Effect (2)*
A:
- [Acute decompensated chronic CHF] in hospitalized patients
- HTN
B:
[Human BNP recombinant] tht
- Activates [vascular smooth muscle NPR1/2] and [renal BNP receptors]
- INC cGMP in [vascular smooth muscle] –> vasoDilation
C:
- vasoDilation of arterioles and [renal Afferent arteriole]–> INC GFR
- DCT Natriuresis
