Flashcards in Anti-anginal Drugs Deck (47)
4 types of drugs used to treat angina
b blockers, ca ch blockers, others (2), and organic nitrates
organic nitrates used to treat angina
isosorbide 5 mononitrate
b blockers used to treat angina
propanolol, sotalol, atenolol
ca ch blockers used to treat angina
two other drugs for angina
deep, poorly localized chest arm discomfort associated with stress/exertion
no serum changes or necrosis
treat with rest and nitroglycerin
variant (prinzmetal) angina
at REST, due to transient increases in coronary tone/vasospasms at site of atherosclerotic change
atleast one of the following
1) at rest, >20 min
2) severe and new onset (1 mo)
3) crescendo pattern (more frequent, severe, prolonged)
form of unstable angina, without ST elevation
not fully occluded
AMI (acute Mi)
acute total thrombotic occlusion of coronary artery
ischemic heart disease symptom, substernal discomfort (rarely pain) that can extend to left arm/shoulder/jaw
what is angina due to?
imbalances in oxygen demand-supply --> ischemia
what does unstable angina usually feature?
ruptured coronary atherosclerotic plaque with platelet aggregation --> less BF
BF in coronary circulation
only flows in LV coronaries during diastole
in systole, sub endocardium P>subepicardium P so endo need more time to fill
since RV has smaller forces, RV perfusion continues through diastole AND systole
FA oxidation inhibitor --> enhances glucose oxidation by preventing ATP decrease --> myocardium can function well despite O2 decline
what drug is a FA oxidation inhibitor? effects?
increases coronary BF, delays ischemia, does not affect HR
better LV function
inhibits late inward Na current in heart --> reduces wall tension and less O2 demand
DONT use with liver disease or CYP3A inhibitors
why not use ranolazine with CYP3A inhibitors? or liver disease?
it is metabolized by CPY3A
increased QT with liver disfunction
what drug inhibits late inward Na channel in heart?
act on vessels, mostly venous!
oral/inhalation to avoid first pass
tolerance (break at night) and withdrawal
interacts with PDE5 inhibitors(sildenafil = viagra)
uses: angina, CHF. MI
do not use with: patients on sildenafil/viagra, with hypotension, diastolic heart failure
why cant someone using sildenafil/viagra use an organic nitrate?
sildenafil degrades cGMP
organic nitrates increase cGMP so it would just make the drug ineffective
how do organic nitrates work?
activate guanylyl cyclase --> increase cGMP
phosphatase dephosphorylates myosin light chain and myosin/actin are uncoupled
difference between organic nitrates and ca ch blockers?
ON - just vasculature, mainly dilate veins, does not change contractility of heart
Cach - vasculature AND myocardium, mainly dilate arteries, lower heart contractility!
How do organic nitrates avoid coronary steal?
they mostly affect the LARGE epicardial coronary vessels --> so they avoid the coronary steal when all vessels are dilated
nitroglycerin vs isosorbide dinitrate and isosorbide 5 mononitrate
nitroglycerin has SHORT half life(2-8 min) and low bioavailability
ID - chewable, 2-3 hrs duration
I5M - 5 hrs, cervical ripener in delivery
what drug can be used to ripen cervix in delivery?
isosorbide 5 mononitrate
ca channel blockers
vasculature (mainly arteriodilation) AND myocardium
block Ltype Ca channels --> inhibit ca influx and relax arteries = decreased coronary resistance and increases BF
DONT USE with heart failure patients
side effects: cardiac depression, AV block, bradycardia, CHF
what anti-anginal type drugs decrease heart contractility?
ca channel blockers and B blockers