Pharm Chapter 22 - Angina

Question 1

Two Types of angina

Answer 1

Spontaneous

Induced by Physical Exertion

Question 2

Angina results when:

Answer 2

myocardial oxygen demand exceeds supply resulting in ischemia

Question 3

Drugs for treatment of Angina

Answer 3

all aim to restore balance in supply and demand

Examples: Nitrates, Calcium Channel, Blockers, Beta Blockers

Question 4

Organic Nitrates

Answer 4

Prodrugs activated when converted to NO in the body. Dilate vascular smooth muscle. Systemic vasodilation not just the coronaries, so reduce preload (volume coming into the heart via venous system) and afterload (reduction in pressure that heart pumps against in arteries). Thus myocardial-oxygen demand decreases
Examples: SL Nitroglycerin, ISDN-LA, ISMN-LA
**Must have 8 hr nitrate free window daily
AE: headache, dizziness, orthostasis

Question 5

Beta Blockers

Answer 5

Act on the B-1 receptors in the heart to reduce HR and myocardial contractile force, thus decreasing myocardial oxygen demand.

Question 6

Calcium Channel Blockers

Answer 6

MOA results in peripheral vasodilation (vascular smooth muscle relaxation) and coronary vasodilation that increases myocardial oxygen supply and decreasing cardiac contractility and worklaod. Selective (VSM only) vs Nonselective (VSM and heart)
AE: peripheral edema, constipation

Question 7

Dihydropyridine

Answer 7

amlodipine, felodipine affect vascular smooth muscle less cardiac, and vasodilate coronary arteries and peripheral vasculature

Question 8

Nondihydropyridine

Answer 8

Diltiazem and verapamil effect BOTH vascular smooth muscle and striated cardiac muscle directly

Question 9

Anticoagulants in Angina

Answer 9

To prevent occlusion of coronary vessel- heparin or platelet inhibitors

Question 10

Heparin

Answer 10

acute - to prevent clot formation from ruptured plaques in coronaries. IV heparin or SC LMWH. Block thrombin

Question 11

ASA or clopidogrel

Answer 11

prevention. block prostaglandins that activate platelets during clotting process. (clopidogrel blocks ADP to prevent clotting cascade)

Question 12

Types of Angina

Answer 12

1. Stable (physical exertion) NT and BB tx
2. Unstable - (secondary to plaque) CCB or BB puls anticoagulant tx
3. Variant (coronary vasospasm) CCB tx