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2 - CPR (cardio) > Stable Angina Drugs > Flashcards

Stable Angina Drugs Flashcards

1
Q

What are the drug classes used for stable angina?

A

Nitrates
CCBs
Beta blockers
- And Ranolazine

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2
Q

What are 3 Nitrates?

A

Nitroglycerin
Isosorbide Dinitrate
Isosorbide Mononitrate

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3
Q

What are 3 NON-cardioactive CCBs?

A
  • Dihydropyridines

= Amlodipine, Nifedipine, Nicardipine

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4
Q

What are 2 Cardioactive CCBs?

A
  • NON-dihydropyridines

= Verapamil, Diltiazem

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5
Q

What are 4 Beta blockers?

A

Propranolol
Metoprolol
Atenolol
Nadolol

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6
Q

Stable Angina is the occlusion of coronary arteries due to atherosclerotic plaques (+) by exertion/stress. What is there an imbalance between?

A

Myocardial O2 demand&raquo_space; supply via coronaries

= Chest pain

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7
Q

Stable Angina is the occlusion of coronary arteries due to atherosclerotic plaques (+) by exertion/stress. What is there an imbalance between?

A

Myocardial O2 demand&raquo_space; supply via coronaries

= Chest pain

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8
Q

What are the options to increase blood flow through the coronary arteries?

A

CABG
PCI
Stents

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9
Q

The only treatment approach for stable angina is?

A

Reduce O2 demand/Cardiac work

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10
Q

The only treatment approach for stable angina is?

A

Reduce O2 demand/cardiac work

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11
Q

What are the 4 determinants of myocardial O2 demand?

A

Preload, Afterload, HR and Contractility

– decrease these to decrease O2 demand and imbalance causing chest pain with stable angina

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12
Q

Nitrates have a significant 1st pass effect which means? Which nitrate has slightly higher oral bioavailability?

A

= LOW oral bioavailability

– Isosorbide Mononitrate has higher oral bioavailability

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13
Q

What do Nitrates increase?

A

NO (nitric oxide)

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14
Q

Describe on a molecular level, the MOA for Nitrates

A
  • Increase NO and Guanylyl Cyclase
  • Increases Protein Kinase G
  • Opens K+ channel and causes Smooth m. relaxation
  • Hyperpolarization
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15
Q

Overall, Nitrates cause what to occur to result in decreased O2 demand?

A
  • Increase NO
  • Venous dilation
  • Decreased preload
    = Decrease O2 demand
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16
Q

Which vessels are the most sensitive to Nitrates/Nitric oxide vasodilation?

A

Veins&raquo_space; large A.&raquo_space; small A.

17
Q

How does Tolerance develop to Nitrates?

A

INCREASED generation of superoxide radicals depletes tissue Nitric Oxide
==> (+) sns and retention of salt and water

18
Q

How does Tolerance develop to Nitrates?

A

INCREASED generation of superoxide radicals depletes tissues of Nitric Oxide
==> (+) SNS and retention of salt and water

19
Q

What are the adverse effects seen with Nitrates?

A

Headache (meningeal vasodilation)
Orthostatic hypotension
Elevated SNS activity = elevated HR and BP

20
Q

What are the adverse effects seen with Nitrates?

A

Headaches (meningeal vasodilation)
Orthostatic hypotension
(+) SNS - increased HR and BP

21
Q

What drugs can Nitrates interact with and what occurs?

A

Drugs used to treat erectile dysfunction (-afil)

= severe increase in cGMP which severely DECREASES BP with possible MI

22
Q

What drugs can Nitrates interact with and what happens?

A

Drugs used to treat erectile dysfunction (-afil)

= Increased in cGMP => DECREASE in BP and possible MI

23
Q

CCBs dilate peripheral arteries to decrease BP and afterload. What do the cardioactive CCBs do?

A

Decrease HR and contractility

24
Q

What are possible side effects of CCBs?

A

Cardiac arrest, hypotension, constipation/flushing

25
Q

What do Beta Blockers do?

A
  • Decrease HR and contractility

- Decrease BP which decreases Afterload

26
Q

What are possible side effects seen with Beta blockers?

A

Decreased cardiac output
Bronchoconstriction
Altered lipoprotein and glucose levels

27
Q

MOA for Ranolazine

A

(-) late Na+ current in cardiomyocytes

na/ca exchanger

28
Q

Overall effect of Ranolazine?

A

Normalizes repolarization and decreases mechanical dysfunction

29
Q

When is Ranolazine used?

A

Stable angina is refractory to other treatments

30
Q

In order to decrease HR, preload, contractility, etc. it is best to combine?

A

Nitrates and Beta blockers/CCBs

2 - CPR (cardio) (44 decks)

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