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CV Antianginal Drugs
CV Antianginal Drugs
27
Medical
Professional
11/09/2010

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Term
What is the pathophysiology of angina?
Definition
Coronary arteries have atherosclerotic plaques and can't dilate during exertion
Coronary arteries can't inc. flow
Imbalance of cardiac O2 demand and supply
Ischemia
Angina
Term
Factors that affect cardiac O2 demand (3)
Definition
HR
dp/dt
LV wall tension
Diastolic tension determined by: preload, radius
Systolic tension determined by: preload, dp/dt, afterload
Term
Subepicardium is perfused during ___ while the endocardium is perfused during ___
Definition
Systole and diastole
Diastole (systole squeezes the arteries shut)
Term
What is the rate-pressure product?
Definition
Rate-pressure product = HR x SBP
Term
What is LaPlace's law?
Definition
Wall tension = intraventricular pressure x radius/(2 wall thickness)
Term
What does the rate-pressure product tell us?
Definition
Incorporates the major factors that determine O2 demand = measures myocardial O2 demand
In pt w/ stable angina, when rate-pressure product reaches some constant value pt will develop angina
Decreasing rate-of-rise of the rate-pressure product inc. exercise tolerance
Term
Angina can be prevented/relieved by...(2)
Definition
Dec. cardiac O2 demand
Inc. cardiac O2 delivery
Term
Cardiac O2 demand can be dec. by...(3)
Definition
Prevent exercise symp.-mediated inc. of HR and dp/dt
Dec. preload = dec. wall tension during the systole and diastole
Dec. afterload = dec. wall tension during systole
Term
Cardiac O2 delivery can be inc. by...(4)
Definition
Dilate large epicardial arteries and endocardial arterioles
Inc. collateral flow to ischemic areas
Dec. preload = dec. wall tension during systole and diastole
Dec. HR
Term
Classes of anti-anginal drugs
Definition
B-blockers
Nitrate VD
Ca channel blockers
Term
Anti-anginal B-blockers
Definition
Atenolol
Metoprolol
Propranolol
Timolol
Term
B-blockers: MOA
Definition
Block B-adrenoR
Prevent symp. nervous system from stim. the heart
Term
B-blockers: effects (3)
Definition
Dec. HR = inc. time in diastole = inc. blood flow to endocardium
Dec. dp/dt = dec. wall tension during systole
Dec. afterload
Term
B-blockers: S/E (3)
Definition
Bronchoconstriction
Dec. dp/dt = acute exacerbation of HF
Sudden withdrawal can cause MI
Term
Isosorbide nitrates and topical NTG, late sublingual NTG: MOA, effects
Definition
Dilate veins
Dec. preload = dec. wall tension during systole and diastole = dec. O2 demand, inc. endocardial blood flow
(afterload unchanged)
Term
Isosorbide nitrates and topical NTG, late sublingual NTG have no effect on...
Definition
DBP (afterload)
HR
dp/dt
Term
Nitrates: summary of effects
Definition
Dec. preload = dec. systolic and diastolic wall tension = dec. O2 demand, inc. subendocardial blood flow
Term
What effect do nitrates have on platelet aggregation?
Definition
Inhibition
Term
How can one avoid tolerance to nitrates?
Definition
Disappears after the drug is w/drawn for a short period of time = use an appropriate dosing schedule
Remove patches at night, dose p.o. at 7am and 2pm
Term
Nitrates: S/E
Definition
Headache (lets you know the pills are still active)
Orthostatic hypotension
Term
Nitrates: indications
Definition
CHF (dec. venous return)
MI (minimize size of tissue damage)
Term
Ca channel blockers
Definition
Amlodipine
Diltiazem
Felodipine
Verapamil
Term
Verapamil, diltiazem: MOA/effects
Definition
Dec. AV conduction, HR, dp/dt (dec. wall tension during systole), SV, CO
A little relaxation of arteriolar smooth muscle = small dec. in DBP (but not enough to cause a baroreflex inc. in sympathetic activity)
Term
Verapamil, diltiazem: summary of effects
Definition
Dec. HR
Dec. dp/dt, DBP = dec. wall tension during systole
Dilate epicardial and endocardial arterioles!!!
Inc. endocardial and collateral blood flow
Term
CCAs are effective in ___ angina b/c ___
Definition
Prinzmetal's
Prevent the vasospasm in the epicardial arteries
Term
Verapamil, diltiazem: S/E
Definition
Bradycardia (counteract w/ CaCl)
SA nodal failure, AV block
HF in patients w/ systolic dysfxn
Inc. risk of MI from excessive VD causing inc. sympathetic drive (come in slow release)
Hypotension
GERD
Verapamil: constipation
Term
Verapamil, diltiazem: drug-drug interactions
Definition
Verapamil IV: +B-blockers = overt HF or severe bradycardia w/ AV block
Verapamil: can inc. plasma [digoxin]
Verapamil, diltiazem: +digoxin potentiate slowing of AV conduction
Diltiazem: +cimetidine blocks CYP and can inc. plasma [diltiazem]
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