Vasodilators in Angina Flashcards
HR and contractility are decreased with ___ and ____.
Beta-blockers and some Ca++ channel blockers
Flow to ischemic subendocardial tissue is improved with _____, _____, and _____.
nitrates, Beta-blockers, and Ca++ channel blockers
Coronary blood flow is increased with _____ and _____.
nitrates; Ca++ channel blockers
Preload is decreased by _____.
nitrates
Afterload is decreased by _____.
Ca++ channel blockers
What does CCB stand for?
Ca++ channel blockers
How do you treat Variant/Prinzmetal Angina?
vasodilators: nitrates and Ca++ channel blockers
Unstable angina is ACUTELY treated with?
clot: aspirin, heparin, GPIIB-IIIA inhibitors, PTCA/CABG,
fibrinolytics
arrhythmia: Beta-blockers
pain: NTG, morphine
What is the post-MI treatment?
ACEIs, statins, blockers, aspirin, clopidrogel (if post-stent).
How do nitrates work?
converted to nitric oxide (NO) at or near the plasma membrane of vascular smooth muscle cells –> increasing cGMP–> relaxation of smooth muscle
What is the best route for nitrate admin?
sublingual
What is the t1/2 of a nitrate?
2-8 min
What are some important SEs for nitrates?
low BP, headache, tolerance
Name 3 Ca++ channel blockers.
- Verapamil (Calan)
- Diltiazem (Cardizem)
- Nifedipine (Procardia)
What are these drugs?
- Verapamil (Calan)
- Diltiazem (Cardizem)
- Nifedipine (Procardia)
Ca++ channel blockers
How do Ca++ channel blockers work?
Block of L-type Ca++ channels in cardiac and smooth muscle –> smooth muscle relaxation
Which Ca++ channel blocker should NOT be used?
Nifedipine (Procardia)
When are Ca++ channel blockers used?
- angina
- arrhythmias
- HTN
What are the important SEs of Ca++ channel blockers?
- cardiac depression
2. flushing, edema, dizziness, nausea, constipation
What is Ranolazine (Ranexa)?
an inhibitor of the late Na+ current
When is Ranolazine (Ranexa) used?
as an add on for angina or as a sub. for beta-blockers
Use this as an add on for angina or as a sub. for beta-blockers.
Ranolazine (Ranexa)
What are some important SEs for Ranolazine (Ranexa)?
- QT prolongation
2. other CV effects (less common)
When is a beta-blocker used for angina?
in stable angina with a concurrent arrhythmia or HTN
Which beta-blocker is used in angina?
Metoprolol (Lopressor), atenolol
Use this drug in a pt with stable angina with a concurrent arrhythmia or HTN.
Metoprolol (Lopressor) or atenolol– both beta blockers
What is Metoprolol (Lopressor)?
a beta blocker
When is Metoprolol (Lopressor) contraindicated?
in asthmatics or with peripheral vascular disorders
Name 2 nitrates.
- nitroglycerin (NTG)
2. oral nitrates
