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Flashcards in Anti-anginal Drugs Deck (47)
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1

4 types of drugs used to treat angina

b blockers, ca ch blockers, others (2), and organic nitrates

2

organic nitrates used to treat angina

nitroglycerin
isosorbide dinitrate
isosorbide 5 mononitrate

3

b blockers used to treat angina

propanolol, sotalol, atenolol

4

ca ch blockers used to treat angina

verapimil
diltiazem
nifedipine
nimodipine

5

two other drugs for angina

trimetazidine
ranolazine

6

stable angina

deep, poorly localized chest arm discomfort associated with stress/exertion
no serum changes or necrosis
treat with rest and nitroglycerin

7

variant (prinzmetal) angina

at REST, due to transient increases in coronary tone/vasospasms at site of atherosclerotic change
*ST elevations

8

unstable angina

atleast one of the following
1) at rest, >20 min
2) severe and new onset (1 mo)
3) crescendo pattern (more frequent, severe, prolonged)

9

NSTEMI

form of unstable angina, without ST elevation
not fully occluded

10

AMI (acute Mi)

acute total thrombotic occlusion of coronary artery

11

angina

ischemic heart disease symptom, substernal discomfort (rarely pain) that can extend to left arm/shoulder/jaw

12

what is angina due to?

imbalances in oxygen demand-supply --> ischemia

13

what does unstable angina usually feature?

ruptured coronary atherosclerotic plaque with platelet aggregation --> less BF

14

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

15

Ca2+ induces....
NO induces...

vascular contraction
vasodilation

16

trimetazidine

FA oxidation inhibitor --> enhances glucose oxidation by preventing ATP decrease --> myocardium can function well despite O2 decline

17

what drug is a FA oxidation inhibitor? effects?

trimetazidine
increases coronary BF, delays ischemia, does not affect HR
better LV function

18

ranolazine

inhibits late inward Na current in heart --> reduces wall tension and less O2 demand
DONT use with liver disease or CYP3A inhibitors

19

why not use ranolazine with CYP3A inhibitors? or liver disease?

it is metabolized by CPY3A

increased QT with liver disfunction

20

what drug inhibits late inward Na channel in heart?

ranolazine

21

organic nitrates

act on vessels, mostly venous!
release NO
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

22

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

23

how do organic nitrates work?

release NO
activate guanylyl cyclase --> increase cGMP
phosphatase dephosphorylates myosin light chain and myosin/actin are uncoupled
=vasodilation!!

24

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!

25

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

26

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

27

what drug can be used to ripen cervix in delivery?

isosorbide 5 mononitrate

28

ca channel blockers

vasculature (mainly arteriodilation) AND myocardium
block Ltype Ca channels --> inhibit ca influx and relax arteries = decreased coronary resistance and increases BF
DECREASES contractility
DONT USE with heart failure patients
side effects: cardiac depression, AV block, bradycardia, CHF

29

what anti-anginal type drugs decrease heart contractility?

ca channel blockers and B blockers

30

what anti-anginal drug should you NOT use with heart failure patients

ca channel blockers!