Pharm: Antianginal drugs

Question 1

What are the drug therapies for exertional angina?

Answer 1

Nitrates
CCBs
Beta blockers
Ranolazine
Ivabradine

Question 2

Describe the mechanism of action of nitrates

Answer 2

Nitrates cause endothelium independent smooth muscle relaxation by activating GC to increase cGMP, dephosphorylates myosin light chains

Decreased venous return, decreased LV wall tension, reduced afterload and direct coronary artery vasodilation

Question 3

Where in the body are nitrates most effective?

Answer 3

Systemic circulation

Question 4

Clinical use of nitrates

Answer 4

Angina pectoris
Hypertensive emergencies
CHF

Question 5

What are the most commonly used nitrates for angina?

Answer 5

Nitroglycerin

Isosorbide mono/dinitrate

Question 6

Are nitrates used prophylactically?

Answer 6

Yes. They can be used as treatment or prophylaxis for exertional angina.

Question 7

What are the side effects of nitrates?

Answer 7

Exaggeration of therapeutic effects: 
-orthostatic hypotension
-reflex tachycardia
-headache
Tolerance can also develop

Question 8

How do calcium channel blockers affect the action potential?

Answer 8

Slower AP upstroke, slowed conduction velocity

Inhibition of Ca influx during AP and also during diastole

Question 9

What are the clinical uses of calcium channel blockers?

Answer 9

Angina Pectoris
Hypertension
Arrhythmias
Hypertrophic cardiopyopathy
Migraine
Raynaud's phenomenon

Question 10

What are the calcium channel blockers used for angina?

Answer 10

Dihydropyridines: nifedipine, nicardipine, amlodipine
Verapamil
Diltiazem
Bepridil

Question 11

Which CCB has the strongest negative inotropic and chronotropic effects?

Answer 11

Verapamil has the strongest inotropic and chronotropic effects

Question 12

Which CCB has the strongest vasodilatory effect?

Answer 12

Nifedipine

Question 13

What are the side effects of verapamil and diltiazem?

Answer 13

Bradycardia
CHF
Heart block
Hypotension

Question 14

What are the side effects of nifedipine?

Answer 14

Reflex tachycardia: major adverse effect
Peripheral edema
Hypotension

Question 15

What are the effects of cAMP in cardiac muscle?

Answer 15

Inotropy, lusitropy, chronotropy, dromotropy

Question 16

What are the most used beta blockers for exertional angina?

Answer 16

Cardioselective: atenolol and metoprolol

Question 17

Describe the elimination of beta blockers

Answer 17

Liver: Propranolol, carvedilol, metoprolol
Kidney: atenolol, nadolol, sotalol

Question 18

What are the side effects of beta blockers?

Answer 18

Bronchospasm
Peripheral vasospasm
Exaggerated cardiac effects: bradycardia, heart block
CNS effects: insomnia, depression, fatigue

Question 19

What are the contraindications for beta blockers?

Answer 19

Acute CHF
Bradycardia, heart block
Peripheral vascular disease
Insulin-dependent diabetes mellitus
Sexual impotence
Bronchospasm

Question 20

What is ranolazine?

Answer 20

New class of antianginal drugs with a unknown mechanism
Inhibits pFOX, decreasing beta oxidation

Question 21

What is ivabradine?

Answer 21

Funny current inhibitor

Newest anti-anginal drug

Question 22

What are the side effects of ivabradine?

Answer 22

Luminous phenomena, bradycardia, AV block

Question 23

Describe the effect of metoprolol on exercise performance

Answer 23

Decreases variation in heart rate and reduces ischemic changes in response to exercise

Question 24

What are the nonpharmacological treatments of angina pectoris?

Answer 24

Exercise training
Angioplasty
Atherectomy
Stents
Intra-aortic balloon counterpulsation
CABG