Treatment of Angina

Question 1

• high blood pressure
• high LDL cholesterol
• smoking
• diabetes, obesity, poor diet, physical inactivity, excessive alcohol use
• risk factors for?

Answer 1

CAD

Question 2

• characterized by chest discomfort when amt of blood delivered to heart by coronary arteries cannot supply enough oxygen to satsify the myocardial requirement
• immediate relief - organic nitrates
• prophylaxis: CCBs and beta blockers

Answer 2

angina pectoris

Question 3

• atheromatous obstruction of large coronary arteries, esp with exercise
• if uncontrolled by drugs may require coronary bypass or angioplasty

Answer 3

classic or atherosclerotic “angina of effort”

Question 4

• spasm or constriction in atherosclerotic coronary vessels

- relieved by nitrates or CCBs

Answer 4

variant/angiospastic/Prinzmetal’s angina

Question 5

• imbalance between oxygen supply and oxygen demand by myocardium
• oxygen demand depends on cardiac workload determined by contractility, HR, wall stress
• frequently during exercise or sympathetic discharge

Answer 5

myocardial ischemia

Question 6

• main source of energy in heart is fatty acid oxidation

- drugs like ________ shift myocardial metabolism towards greater use of glucose, a pFOX inhibitor

Answer 6

trimetazidine

Question 7

reduces intracellular calcium concnetration and reduces cardiac contractility and work

Answer 7

ranolazine

Question 8

inhibits xanthine oxidase (which contributes to oxidative stress and endothelial dysfunction, high dose prolongs exercise time in patients with angina

Answer 8

allopurinol

Question 9

amy nitrite, sublingual nitroglycerin, and sublingual isosorbide dinitrate are ______ nitrates used for angina

Answer 9

short acting

Question 10

oral nitroglycerin, buccal nitroglycerin, oral isosorbide dinitrate and mononitrate are _______ nitrates

Answer 10

long acting

Question 11

nitrates preferentially dilate _______

Answer 11

large veins

Question 12

other effects of NO:

• ______, a PDE-5 inhibitor, can potentiate action of NO in angina, cause severe hypotension
• increased cGMP in platelets ______ aggregation
• nitrite ion reacts with hemoglobin to produce ________, which can be used to treat cyanide poisoning b/c it regenerates cytochrome oxidase

Answer 12

sildenafil

decrease

methemoglobin

Question 13

harmful nitrate effects:

• reflex increases in HR and contractility _______ myocardial O2 demand
• reflex tachy causes ______ perfusion due to shorter _______

Answer 13

increase

decreased, diastole

Question 14

nitroglycerin and isosorbide dinitrate are preferred sublingual for rapid absorption and to avoid __________

Answer 14

hepatic destruction

Question 15

IV sodium nitroprusside dilates _________ evenly

Answer 15

arteries and veins

Question 16

• acute nitrate toxicity can cause strong vasodilation leading to ______ and _____
• Monday disease - tolerance diminishes on weekend, headache and dizziniess upon reexposure

Answer 16

orthostatic hypotension, tachycardia, headaches

Question 17

• orally active drugs that block L type channels in myocardium and vascular smooth muscles
• arterioles more sensitive than veins

Answer 17

CCBs

Question 18

verapamil has most sensitivity for _____ muscle and nifedipine has strongest selectivity for _______ muscle

Answer 18

cardiac

vascular smooth

Question 19

• decrease contractility, reduce SA node impulse generation, slow AV node conduction
• ________ most likely to produce reflex tachycardia
• _______ most likely to cause myocardial depression

Answer 19

CCBs

nifedipine

verapamil

Question 20

• inhibition of insulin secretion
• interference with platelet aggregation
• flushing, dizziness, constipation
• reduce digoxin clearance

Answer 20

CCB side effects

Question 21

• decrease sympathetic tone to decrease cardiac output

- reduce myocardial oxygen requirements at rest and during exercise

Answer 21

b-blockers (atenolol, metoprolol, propanolol)

Question 22

• have been shown to reduce mortality in patients with MI, improve survival and prevent stroke in hypertensive patients
• do not dilate coronary arteries
• bradycardia prolongs diastole and increases myocardial perfusion time
• may induce or worsen CHF

Answer 22

beta blockers

Question 23

treatment of angina pectoris in a patient with hypertension?

Answer 23

monotherapy with slow release CCB or beta blocker

Question 24

treatment of angina in normotensive patient?

Answer 24

long acting nitrates