Pharm Test 8

Question 1

Angina Pectoris 4 Types

Answer 1

= sudden chest pain (lack of O2)

1) Classic/stable/effort-induced/typical= coronary obstruction, patterns are stable, pain helped with rest or nitroglycerin
2) Unstable= chest pain with less effort, pain not relieved by rest or nitroglycerin
3) Rest/Prinzmetal/Varient/Vasospastic= pain at rest because of spasms, treated with Ca blockers and nitroglycerin
4) Acute Coronary Syndrome= rupture of atherosclerotic plaque, shows up as elevated ST, MI or unstable angina

Question 2

Angina Drug Strategies

Answer 2

1) increase O2 delivery (increase coronary BF)

2) decrease O2 demand (decrease HR, contractility, vol, pressure)

Question 3

4 Types of Drugs for Angina

Answer 3

1) beta blockers
2) Ca channel blockers
3) Organic Nitrates
4) Na channel blockers

Question 4

Beta Blockers (for Angina)

Answer 4

atenolol, bisoprolol, metoprolol, propranolol (non selective)
- lowers O2 demand by blocking beta1 (lowers HR, BP, contractility), and lowers renin= less CBV, increases exercise tolerance
= initial therapy, good for HTN, HF
Adverse effects- bradycardia, hypotension, fatigue, insomnia

Question 5

Calcium Channel Blockers (for Angina)

Answer 5

amlodipine, felodipine, nifedipine, diltiazem, verapamil
- lowers O2 demand and increase O2 delivery
-blocking Ca= relaxes smooth muscle, decrease heart contractility, decreases after load and increases coronary dilation
Adverse Effects- AV block, dizzy, low BP, edema (don’t use with CAD!)

Question 6

Organic Nitrates (for Angina)

Answer 6

nitroglycerin, isosorbide dinitrate, isosorbide mononitrate
- vasodilation by NO= increase O2 delivery, lowers preload= decrease O2 demand (at high dose= decrease after load)
Adverse Effects- throbbing headaches, at high doses= orthostatic hypotension, facial flushing, reflex tachycardia

Question 7

Sodium Channel Blockers (for Angina)

Answer 7

ranolazine (for chronic angina)
-inhibing Na helps inhibit Ca influx= lower contractility (lowers O2 demand), NO change in HR or Contractility
Adverse Effects- prolong QT, consitpation, nausea, dizzy headache

Question 8

Opium Alkaliod

Answer 8

papaverine
- (Ca channel blocker)- causes relaxations, DIRECT smooth muscle relax
prevents spasms

Question 9

Drugs for Angina that relieve spasms

Answer 9

diltiazem, amlodipine, papaverine

Question 10

Adenosine

Answer 10

vascular smooth muscle relaxer, inhibit Ca entry
vascular- increase cAMP= dilation
heart- decrease cAMP= dilation
-used in stress test, lowers AV conduction, coronary steal

Question 11

Management of Stable Angina

Answer 11

change lifestyle, sublingual nitorglycerin, beta blockers, Ca blockers, low dose asprin

Question 12

Order of Drugs to try for Angina

Answer 12

1) sublingual nitroglycerin
2) beta blockers
3) Ca Blocker OR organic nitrates
4) Na Blocker (ranolazine)