(THER) Anti-anginal drugs

Question 1

Most frequent cause of Myocardial Ischemia

Answer 1

Atherosclerosis

Question 2

Prinzmetal Angina

Answer 2

Coronary artery spasm which tends to wake patients from sleep

Question 3

NO causes smooth muscle relaxation even in the abscence of _______ ____________.

Answer 3

Normal Endothelium

(it shows endothelium-independent relaxation)

Question 4

MOA of NO

Answer 4

Activates Guanyl Cyclase, increasing cGMP and dephosphorylating Myosin Light Chains. This ultimately produces smooth muscle relaxation.

Question 5

What effect do nitrates have on the heart/systemic circulation (4)

Answer 5

1. Decreased Venous Return (dilates venous vessels)
2. Reduced LV Wall Tension
3. Reduced Afterload
4. DIrect Coronary Artery Vasodilatation (increased subendocardial perfusion)

Question 6

What forms nitroglycerin come in? (4)

Answer 6

1. Sublingual
2. Bucchal spray
3. Patch
4. Ointment

Question 7

What forms do Isosorbide mono/dinitrate come in?

Answer 7

1. Sublingual
2. Chewable
3. Oral

Question 8

What can occur if nitrates are taken on too consistent of a basis?

Answer 8

The patient can develop a nitrate tolerance

Question 9

How does Verapamil lead to smooth muscle relaxation?

Answer 9

It is a CCB so it blocks the ability of Calcium channels to cause smooth muscle contraction.

Question 10

Name the (3) main CCBs

Answer 10

1. Dihydropyridines (Nifedipine)
2. Verapamil
3. Diltiazem

Question 11

What is the order of strength of CCBs based on their negative inotropic effects?

Answer 11

Verapamil > Diltiazem > Nifedipine

Question 12

What is the order of strength of CCBs based on their negative chronotropic effects?

Answer 12

Verapamil > Diltiazem > Nifedipine

Question 13

What is the order of strength of CCBs based on their Vasodilatory effects?

Answer 13

Nifedipine > Diltiazem > Verapamil

Question 14

CCB AEs

Answer 14

VERAPAMIL & DILTIAZEM

1. Bradycardia
2. Congestive Heart Failure
3. Heart Block
4. Hypotension

NIFEDIPINE

1. Reflex Tachycardia
2. Peripheral Edema
3. Hypotension

Question 15

B1 receptors are coupled to ____ and ultimately cause _____ increase.

Answer 15

Gsa

cAMP increase

Question 16

If the patient’s Liver is working well, which B-blockers are preferred? Kidneys?

Answer 16

Liver: Propanolol, Carvedilol, Metoprolol

Kidneys: Atenolol, Nadolol, Sotalol

Question 17

Contraindications to administration of B-blockers (7)

Answer 17

I’M A BASS

1. Insulin-Dependent Diabetes Mellitus
2. Marked bradycardia (HR<55 bpm)
3. Acute Congestive Heart Failure
4. Bronchospasm
5. Advanced AV block (1st, 2nd or 3rd Degree)
6. Severe Peripheral Vascular Disease
7. Sexual Impotence
   8.

Question 18

Ranolazine is used for…

Answer 18

It is a new class of anti-anginal drugs. Its mechanism is currently unclear.

Question 19

Ivabradine MOA

Answer 19

New Anti-anginal Drug

FUnctions by blocking I_F (funny channel). This thereby inhibits pacemaker activity, slowing the HR at rest and during excercise.

Question 20

Key AE of Ivabradine

Answer 20

Luminous Phenomena

Question 21

Name some of the nonpharmacological Tx of Angina Pectoris

Answer 21

1. Exercise Training
2. Angioplasty
3. Atherectomy
4. Stents
5. Intra-Aortic Balloon Counterpulsation
6. Coronary Artery Bypass Grafting (CABG)