Pharmacology of Drugs Used to Treat Angina

Question 1

What is angina

Answer 1

chest pain or discomfort due to coronary artery disease

Question 2

What are typical symptoms of angina

Answer 2

Pressure, squeezing or pain in the center of heart

Question 3

T/F: Angina pectoris is a consequence of myocardial oxygen demand exceeding myocardial oxygen supply

Answer 3

True

Question 4

What causes the pain in angina

Answer 4

acidic metabolites accumulate and stimulate myocardial pain nerve endings

Question 5

In a heart EKG what is the main difference for a patient with angina

Answer 5

ST segment is depressed

Question 6

What are the three types of angina

Answer 6

Stable angina, unstable angina, and prinzemetal’s angina

Question 7

What causes stable angina, what relieves stable angina

Answer 7

Stable plaque reduces maximal capacity of coronary artery, nitroglycerin and rest

Question 8

What causes unstable angina

Answer 8

Atherosclerotic plaque ruptures causing a platelet pug to form blocking (clotting) flow to the heart muscle

Question 9

What causes prinzmetal’s angina

Answer 9

Coronary artery spasm causes transient reduction of blood flow

Question 10

T/F: Both unstable and stable angia are predictable and occur at rest and therefore should not be treated as an emergency

Answer 10

False: Stable angina is predictable while unstable angina occurs at resting and should therefore be treated as an emergency

Question 11

What are the short term goals of angina/ long term goals

Answer 11

reduce or prevent anginal symtoms that limit exercise capability and impair quality of life/ prevent MI, arrhythmias, heart failure and extend the patient’s life

Question 12

What is the do of organic nitrates for immediate short-term relief

Answer 12

Dilate systemic veins causing less venous return to the heart

Question 13

What effects do organic nitrates have on the heart and its parameters

Answer 13

preload decreases, ventricular wall stress reduces, cardiac output reduces, reduces myocardial O2 demand (workload of heart reduces)

Question 14

T/F: At higher doses arterioles are affected leading to blood pressure decreases but also possibly reflex tachycardia

Answer 14

True

Question 15

T/F: Efficacy of nitrates pertains to their ability to act as a coronoary vasodilator

Answer 15

False: Efficacy of nitrates pertain to their ability to decrease myocardial oxygen demand rather than activity as a coronorary vasodilator

Question 16

What is the MOA of nitroglycerin

Answer 16

Nitroglycerin enters vascular smooth muscle were it is converted to a nitric oxide (NO), NO activates guanyl cycles increasing cGMP causing dephosphorylation of myosin light phosphate all leading to relaxation

Question 17

Why are sublingual nitrates preferred

Answer 17

bioavailabitly is best due to avoiding extensive first pass metabolism

Question 18

If a nitrate is taken and there is no pain relief immediately what should the patient do

Answer 18

Contact emergency medical services if there is no pain relief after five minutes or if pain worsens while also taking more nitroglycerin in five minute intervals (up to 3 doses)

Question 19

What is nitrate given orally with excellent bio-availability, what is the active metabolite

Answer 19

Isorbide dinitrate, mononitrate

Question 20

What is the dosing for isosorbid mononitrate immediate release tablet (ISMO, sustained-release preparation (Imdur)

Answer 20

two times daily, 7 hours apart/ once daily

Question 21

When is a sublingueal nitroglycerin tablet preferred

Answer 21

acute anginal attacks, acute prophylaxis

Question 22

When would a long acting preparation be preffered

Answer 22

Sustained protection against angina attacks

Question 23

What is the most common side effect, what causes this side effect, what is a another side effect

Answer 23

headache, cerebral dilation, flushing

Question 24

What drugs do nitrates have interactions with, how long must the drugs be seperated

Answer 24

Viagra, Levitra, Cialis/ 24 hours (V and L), 48 hours (C)

Question 25

How do erectile dysnfunction drugs interact with Nitrates

Answer 25

Sildenafil increase cGMP by inhibiting its breakdown by PDE-5 leading to severe hypotension

Question 26

T/F: Tachycardia and dizzines are side effects from nitrates due to compensatory effects resulting from baroreceptor reflex

Answer 26

True

Question 27

What is the first line therapy in chronic stable angina,

Answer 27

Beta blockers

Question 28

How do beta blockers reduce myocardial oxygen demand (beta 1 effect) by decreasing what

Answer 28

Heart rate, contractility and blood pressure (reducing left ventricular wall stress)

Question 29

What is the most common non selective beta blocker, cardioselective

Answer 29

propranolol, atenolol and metoprolol

Question 30

T/F: CCBs would be used to treat acute angina

Answer 30

False: CCBs are used to treat stable (chronic) angina pectoris and vasospatic angina

Question 31

What is the mechanism of the non-DHP CCBs

Answer 31

Blocks the initial calcium influx associated with formation of Calcium-tropoin complexes in the heart muscle therefore not allowing actin and myosin to cause contraction (decreased contractility)

Question 32

What is the mechanism of the DHP CCBs

Answer 32

Blocks the initial calcium influx associated with formation of calcium-calmodium complexes in the vascular smooth muscle therefore not allowing actin and myosin to cause contraction (vasodilation)

Question 33

T/F: Ranazoline is a last resort for patients that can be used with BB and nitrates and Amlodipine (not other CCBs) but may cause BP increase and prolongation of the QT interval.

Answer 33

True