Stable Angina Drugs Flashcards
What are the drug classes used for stable angina?
Nitrates
CCBs
Beta blockers
- And Ranolazine
What are 3 Nitrates?
Nitroglycerin
Isosorbide Dinitrate
Isosorbide Mononitrate
What are 3 NON-cardioactive CCBs?
- Dihydropyridines
= Amlodipine, Nifedipine, Nicardipine
What are 2 Cardioactive CCBs?
- NON-dihydropyridines
= Verapamil, Diltiazem
What are 4 Beta blockers?
Propranolol
Metoprolol
Atenolol
Nadolol
Stable Angina is the occlusion of coronary arteries due to atherosclerotic plaques (+) by exertion/stress. What is there an imbalance between?
Myocardial O2 demand»_space; supply via coronaries
= Chest pain
Stable Angina is the occlusion of coronary arteries due to atherosclerotic plaques (+) by exertion/stress. What is there an imbalance between?
Myocardial O2 demand»_space; supply via coronaries
= Chest pain
What are the options to increase blood flow through the coronary arteries?
CABG
PCI
Stents
The only treatment approach for stable angina is?
Reduce O2 demand/Cardiac work
The only treatment approach for stable angina is?
Reduce O2 demand/cardiac work
What are the 4 determinants of myocardial O2 demand?
Preload, Afterload, HR and Contractility
– decrease these to decrease O2 demand and imbalance causing chest pain with stable angina
Nitrates have a significant 1st pass effect which means? Which nitrate has slightly higher oral bioavailability?
= LOW oral bioavailability
– Isosorbide Mononitrate has higher oral bioavailability
What do Nitrates increase?
NO (nitric oxide)
Describe on a molecular level, the MOA for Nitrates
- Increase NO and Guanylyl Cyclase
- Increases Protein Kinase G
- Opens K+ channel and causes Smooth m. relaxation
- Hyperpolarization
Overall, Nitrates cause what to occur to result in decreased O2 demand?
- Increase NO
- Venous dilation
- Decreased preload
= Decrease O2 demand
Which vessels are the most sensitive to Nitrates/Nitric oxide vasodilation?
Veins»_space; large A.»_space; small A.
How does Tolerance develop to Nitrates?
INCREASED generation of superoxide radicals depletes tissue Nitric Oxide
==> (+) sns and retention of salt and water
How does Tolerance develop to Nitrates?
INCREASED generation of superoxide radicals depletes tissues of Nitric Oxide
==> (+) SNS and retention of salt and water
What are the adverse effects seen with Nitrates?
Headache (meningeal vasodilation)
Orthostatic hypotension
Elevated SNS activity = elevated HR and BP
What are the adverse effects seen with Nitrates?
Headaches (meningeal vasodilation)
Orthostatic hypotension
(+) SNS - increased HR and BP
What drugs can Nitrates interact with and what occurs?
Drugs used to treat erectile dysfunction (-afil)
= severe increase in cGMP which severely DECREASES BP with possible MI
What drugs can Nitrates interact with and what happens?
Drugs used to treat erectile dysfunction (-afil)
= Increased in cGMP => DECREASE in BP and possible MI
CCBs dilate peripheral arteries to decrease BP and afterload. What do the cardioactive CCBs do?
Decrease HR and contractility
What are possible side effects of CCBs?
Cardiac arrest, hypotension, constipation/flushing
What do Beta Blockers do?
- Decrease HR and contractility
- Decrease BP which decreases Afterload
What are possible side effects seen with Beta blockers?
Decreased cardiac output
Bronchoconstriction
Altered lipoprotein and glucose levels
MOA for Ranolazine
(-) late Na+ current in cardiomyocytes
na/ca exchanger
Overall effect of Ranolazine?
Normalizes repolarization and decreases mechanical dysfunction
When is Ranolazine used?
Stable angina is refractory to other treatments
In order to decrease HR, preload, contractility, etc. it is best to combine?
Nitrates and Beta blockers/CCBs
