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Pharm > Vasodilators and the Angina pectoris > Flashcards

Vasodilators and the Angina pectoris Flashcards

1
Q

What are the 3 drug classes mainly used for angina

A

nitrates
CCBs
Beta blockers

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2
Q

How does medication help with angina

A

decreases how much oxygen the heart needs by decreasing one or more of these things: heart size, heart rate, blood pressure, and contractility

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3
Q

Nitrates and calcium channel blockers may help by angina by___ and help variant angina by ____

A

causing a redistribution of coronary flow and increase oxygen delivery to ischemic tissue
In variant angina, they help by reversing coronary artery spasm.

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4
Q

Nitro: What are the 3 considerations

A

store in an air tight container due to loss of potency
may develop tolerance
due to low bioavailability, sublingual route is preferred to achieve rapid response; sustained effect is limited to 15-30 minutes

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5
Q

Nitro: must be stored in

A

air tight container due to loss of potency

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6
Q

Nitro: patient may develop

A

tolerance

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7
Q

Nitro: due to low bioavailability,

A

sublingual route is preferred to achieve rapid response; sustained effect is limited to 15-30 minutes

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8
Q

Isosorbide: 2 considerations

A

you might develop tolerance

isosorbide mononitrate is the active metabolite of isosorbide dinitrate and has 100% bioavailability.

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9
Q

Whats the main target of nitrates

A

vascular smooth muscle

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10
Q

All 7 Effects of Nitrates:

A
  1. Veins relax so you have less ventricular preload
  2. Pulmonary vascular pressures decrease
  3. Heart size is reduced.
  4. In the absence of heart failure, cardiac output is reduced.
  5. In heart failure, preload is often abnormally high; the nitrates and other vasodilators, by reducing preload, may have a beneficial effect on cardiac output in this condition
  6. The indirect effects of nitroglycerin are tachycardia and increased cardiac contractility.
  7. Retention of salt and water, especially with intermediate- and long-acting nitrates. These compensatory responses contribute to the development of tolerance.
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11
Q

Effects of Nitrates: Veins relax so you have

A

less ventricular preload

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12
Q

Effects of Nitrates: Pulmonary vascular pressures

A

decrease

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13
Q

Effects of Nitrates: Heart size is

A

reduced

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14
Q

Effects of Nitrates: In the absence of heart failure,

A

cardiac output is reduced.

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15
Q

Effects of Nitrates: In heart failure,

A

preload is often abnormally high; the nitrates and other vasodilators, by reducing preload, may have a beneficial effect on cardiac output in this condition

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16
Q

Effects of Nitrates: The indirect effects of nitroglycerin are

A

tachycardia and increased cardiac contractility.

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17
Q

Effects of Nitrates: Retention of

A

salt and water, especially with intermediate- and long-acting nitrates. These compensatory responses contribute to the development of tolerance.

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18
Q

4 Adverse effects of Nitrates

A

orthostatic hypotension
tachycardia
headache
tolerance

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19
Q

Angina of effort

A

myocardial oxygen requirement increases, especially during exercise, and coronary blood flow does not increase proportionately
Not enough blood flow in the presence of CAD, also known as classic angina

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20
Q

Nitrates can be used for 3 types of Angina

A

Angina of effort
Variant angina
Unstable angina

21
Q

Variant angina

A

sometimes you have blood vessel spasms, usually associated with underlying atheromas, can also cause significant myocardial ischemia and pain (vasospastic or variant angina). Vasospastic angina is also called Prinzmetal angina.

22
Q

Unstable angina

A

acute coronary syndrome, is said to be present when episodes of angina occur at rest and there is an increase in the severity, frequency, and duration of chest pain in patients with previously stable angina. Increased coronary artery resistance or small platelet clots occurring in the vicinity of an atherosclerotic plaque. Associated with increased risk of MI

23
Q

All of the ways that CCBs help with angina:

A
  • Decreasing myocardial contractile force, which reduces myocardial oxygen requirements
  • They decreases arterial and intraventricular pressure by blocking arterial smooth muscle
  • Stress on the left ventricular wall decreases
  • They stop coronary artery spasm
  • The sinus node rate is decreased
  • AV node conduction slows down
  • Verapamil and diltiazem also have their own special way, which is that they have an antiadrenergic effect
24
Q

CCBs help with angina by decreasing ___ ___ ___, which reduces myocardial oxygen requirements

A

myocardial contractile force

25
Q

CCBs help with angina by decreasing ___ and ___ ___ by blocking arterial smooth muscle

A

arterial and intraventricular pressure

26
Q

CCBs help with angina by decreasing stress on the ___ wall

A

ventricular wall

27
Q

CCBs help with angina by stopping ___ ___ spasm

A

coronary artery spasm

28
Q

CCBs help with angina by the ___ node rate is ____

A

sinus node rate is decreased, and so is the AV node

29
Q

CCBs help with angina, verapamil and diltiazem spefically help because

A

they have an antiadrenergic effect

30
Q

Is it possible to have so much calcium that the CCBs don’t work?

A

It’s possible, but it’s unlikely because the levels of calcium would have to be super high.

Sympathomimetics can increase calcium getting into the cells, which obviously isn’t good for CCBs

31
Q

calcium channel blockers are ___ active agents

A

orally

32
Q

CCBs have ___ ___-pass effect

A

high first-pass effect

33
Q

CCBs have ____ ____ ____ binding

A

high plasma protein binding

34
Q

CCBs have ____ metabolism

A

extensive metabolism

35
Q

What are the three things that characterize CCBs

A

high first-pass effect
high plasma protein binding
extensive metabolism

36
Q

Verapamil and diltiazem routes

A

oral and IV

37
Q

3 Clinical Uses of Verapamil and diltiazem

A

arrhythmias (AF and atrial flutter)
Unstable angina
Postinfarction angina

38
Q

Clinical Uses of Verapamil and diltiazem: arrhythmias such as

A

AF and atrial flutter

39
Q

What should you know about CCBs for treating unstable angina

A

immediate-release short-acting calcium channel blockers can increase the risk of adverse cardiac events and therefore are contraindicated

40
Q

Clinical Uses of diltiazem: Postinfarction angina

A

Diltiazem can decrease the frequency of and may be used for patients with non–Q-wave myocardial infarction

41
Q

What in general should you know about Adverse Effects of CCBs

A

Adverse effects are rare, but can include really bad things:
serious cardiac depression, including bradycardia, atrioventricular block, cardiac arrest, and heart failure

They can also cause less serious stuff like edema and constipation with verapamil

42
Q

Clinical use for beta blockers

A

Stable angina

43
Q

How do beta blockers help with stable angina

A

decreased heart rate, blood pressure, and contractility, which means there’s less oxygen demand.

Also, since the heart is going slower there is more time for perfusion.

44
Q

5 beta blocker Contraindications

A 
asthma 
severe bradycardia
AV block
bradycardia-tachycardia syndrome
Severe unstable left ventricular failure
45
Q

Adverse effects of Beta blockers

A 
impaired exercise tolerance 
insomnia, 
unpleasant dreams, 
worsening of claudication, 
and erectile dysfunction.
46
Q

Summary: Stable angina can be treated with

A

Nitrates
CCBs
BBs

47
Q

Summary: Vasospastic angina can be treated with

A

Nitrates

CCBs

48
Q

Summary: Unstable angina and acute coronary syndrome

A

Nitrogylcerine
BBs
and for refractory cases CCBs

Pharm (23 decks)

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