(THER) Anti-anginal drugs Flashcards
Most frequent cause of Myocardial Ischemia
Atherosclerosis
Prinzmetal Angina
Coronary artery spasm which tends to wake patients from sleep
NO causes smooth muscle relaxation even in the abscence of _______ ____________.
Normal Endothelium
(it shows endothelium-independent relaxation)
MOA of NO
Activates Guanyl Cyclase, increasing cGMP and dephosphorylating Myosin Light Chains. This ultimately produces smooth muscle relaxation.
What effect do nitrates have on the heart/systemic circulation (4)
- Decreased Venous Return (dilates venous vessels)
- Reduced LV Wall Tension
- Reduced Afterload
- DIrect Coronary Artery Vasodilatation (increased subendocardial perfusion)
What forms nitroglycerin come in? (4)
- Sublingual
- Bucchal spray
- Patch
- Ointment
What forms do Isosorbide mono/dinitrate come in?
- Sublingual
- Chewable
- Oral
What can occur if nitrates are taken on too consistent of a basis?
The patient can develop a nitrate tolerance
How does Verapamil lead to smooth muscle relaxation?
It is a CCB so it blocks the ability of Calcium channels to cause smooth muscle contraction.
Name the (3) main CCBs
- Dihydropyridines (Nifedipine)
- Verapamil
- Diltiazem
What is the order of strength of CCBs based on their negative inotropic effects?
Verapamil > Diltiazem > Nifedipine
What is the order of strength of CCBs based on their negative chronotropic effects?
Verapamil > Diltiazem > Nifedipine
What is the order of strength of CCBs based on their Vasodilatory effects?
Nifedipine > Diltiazem > Verapamil
CCB AEs
VERAPAMIL & DILTIAZEM
- Bradycardia
- Congestive Heart Failure
- Heart Block
- Hypotension
NIFEDIPINE
- Reflex Tachycardia
- Peripheral Edema
- Hypotension
B1 receptors are coupled to ____ and ultimately cause _____ increase.
Gsa
cAMP increase
If the patient’s Liver is working well, which B-blockers are preferred? Kidneys?
Liver: Propanolol, Carvedilol, Metoprolol
Kidneys: Atenolol, Nadolol, Sotalol
Contraindications to administration of B-blockers (7)
I’M A BASS
- Insulin-Dependent Diabetes Mellitus
- Marked bradycardia (HR<55 bpm)
- Acute Congestive Heart Failure
- Bronchospasm
- Advanced AV block (1st, 2nd or 3rd Degree)
- Severe Peripheral Vascular Disease
- Sexual Impotence
8.
Ranolazine is used for…
It is a new class of anti-anginal drugs. Its mechanism is currently unclear.
Ivabradine MOA
New Anti-anginal Drug
FUnctions by blocking IF (funny channel). This thereby inhibits pacemaker activity, slowing the HR at rest and during excercise.
Key AE of Ivabradine
Luminous Phenomena
Name some of the nonpharmacological Tx of Angina Pectoris
- Exercise Training
- Angioplasty
- Atherectomy
- Stents
- Intra-Aortic Balloon Counterpulsation
- Coronary Artery Bypass Grafting (CABG)
