Vasodilators & The Treatment Of Angia Pectoris Flashcards
Isosorbide mononitrate
Nitrate: active metabolite of the dinitrate; used orally for prophylaxis
Nitrates
Nitroglycerin
Isosorbide dinitrate
Isosorbide mononitrate
Isosorbide dinitrate
Nitrate: very similar to nitroglycerin, slightly longer duration of action
Nitroglycerin
Nitrate
Nitroglycerin
Mechanism of action
Releases nitric oxide in smooth muscle, whitch activates guanylyl cyclase and increases cGMP
Releases nitric oxide in smooth muscle, whitch activates guanylyl cyclase and increases cGMP
Nitroglycerin
Mechanism of action
Nitroglycerin
Effects
Smooth muscle relaxation especially in vessels
Other smooth muscle is relaxed but not as markedly
Vasodilation decreases venous return and heart size
May increase flow in some areas and in variant angina
Smooth muscle relaxation especially in vessels
Other smooth muscle is relaxed but not as markedly
Vasodilation decreases venous return and heart size
May increase flow in some areas and in variant angina
Nitroglycerin
Effects
Nitroglycerin
Clinical applications
Angina: sublingual form for acute episodes
Oral and transdermal forms for prophylaxis
IV form for acute coronary syndrome
Angina: sublingual form for acute episodes
Oral and transdermal forms for prophylaxis
IV form for acute coronary syndrome
Nitroglycerin
Clinical applications
Nitroglycerin
Toxicity
Orthostatic hypotension, tachcardia, headache
INTERACTIONS: synergistic hypotension with phosphodiesterase type 5 inhibitors (sildenafil, etc)
Orthostatic hypotension, tachcardia, headache
INTERACTIONS: synergistic hypotension with phosphodiesterase type 5 inhibitors (sildenafil, etc)
Nitroglycerin
Toxicity
Nitrate: very similar to nitroglycerin, slightly longer duration of action
Isosorbide dinitrate
Nitrate: active metabolite of the dinitrate; used orally for prophylaxis
Isosorbide mononitrate
Beta blockers
Propranolol
Atenolol
Metoprolol
Atenolol
Metoprolol
Beta blocker, Beta1-selective blocker, less risk of bronchospam, but still significant
Propranolol
Beta blocker
Propranolol
Mechanism of action
Nonselective competitive antagonist at Beta adrenoceptors
Nonselective competitive antagonist at Beta adrenoceptors
Propranolol
Mechanism of action
Propranolol
Effects
Decreased heart rate, cardiac output, and blood pressure
Decreases myocardial oxygen demand
Decreased heart rate, cardiac output, and blood pressure
Decreases myocardial oxygen demand
Propranolol
Effects
Propranolol
Clinical applications (in angina)
Prophylaxis of angina
Prophylaxis of angina
Propranolol
Clinical applications (in angina)
Propranolol
Toxicity
Asthma Atrioventricular block Acute heart failure Sedation INTERACTION: additive with all cardiac depressants
Asthma Atrioventricular block Acute heart failure Sedation INTERACTION: additive with all cardiac depressants
Propranolol
Toxicity
Calcium channel blockers
Verapamil
Diltiazem
Nifedipine (dihydropyridine)
Verapamil
Calcium channel blocker
Diltiazem
Calcium channel blocker
Nifedipine
Calcium channel blocker
Verapamil
Diltiazem
Mechanism of action
Nonselective block of L-type calcium channels in vessels and heart
Nonselective block of L-type calcium channels in vessels and heart
Verapamil
Diltiazem
Mechanism of action
Verapamil
Diltiazem
Effects
Reduced vascular resistance, cardiac rate, and cardiac force recult in decreased oxygen demand
Reduced vascular resistance, cardiac rate, and cardiac force recult in decreased oxygen demand
Verapamil
Diltiazem
Effects
Verapamil
Diltiazem
Clinical applications
Prophylaxis of angina, hypertension, others
Prophylaxis of angina, hypertension, others
Verapamil
Diltiazem
Nifedipine
Clinical applications
Verapamil
Diltiazem
Toxicity
Atrioventricular block Acute heart failure Constipation Edema INTERACTIONS: additive with other cardiac depressant and hypotensive drugs
Atrioventricular block Acute heart failure Constipation Edema INTERACTIONS: additive with other cardiac depressant and hypotensive drugs
Verapamil
Diltiazem
Toxicity
Nifedipine (dihydropyrdine)
Mechanism of actions
Block of vascular L-type calcium channels > cardiac channels
Block of vascular L-type calcium channels > cardiac channels
Nifedipine (dihydropyrdine)
Mechanism of actions
Nifedipine (dihydropyrdine)
Effects
Like Verapamil and Diltiazem; less cardiac effect
Like Verapamil and Diltiazem; less cardiac effect
Nifedipine (dihydropyrdine)
Effects
Nifedipine (dihydropyrdine)
Clinical applications
Prophylaxis of angina, hypertension
Prophylaxis of angina, hypertension
Nifedipine (dihydropyrdine)
Clinical applications
Nifedipine (dihydropyrdine)
Toxicity
Excessive hypotension
Baroreceptor reflex tachycardia
INTERACTIONS: additive with other vasodilators
Excessive hypotension
Baroreceptor reflex tachycardia
INTERACTIONS: additive with other vasodilators
Nifedipine (dihydropyrdine)
Toxicity
Like nifedipine but slower onset and longer duration (up to 12 h or longer)
Other dihydropyridines
Other dihydropyridines
Like nifedipine but slower onset and longer duration (up to 12 h or longer)
