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Anti-Anginals
Dr. P antianginal
32
Medical
Graduate
10/08/2012

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Term
Metabolic factors formed from hypoxic myocardial tissues?
Definition
Adenosine, Lactate, acetate, H+, CO2
Term
Endothelial factors released from hypoxic cardiac tissue including vasodilators and vasoconstrictors?
Definition
vasodilators: NO, EDHF, and PGI2 (prostacyclin)
Vasoconstrictors: endothelin
Term
Differentiating factors of variant angina?
Definition
it is a typical angina pain that occurs at rest and usually during the same time of day. Caused by coronary spasm and not blockage.
Term
Treatment choices for stable angina?
Other consideration in treating stable angina?
Definition
Long acting nitrates
Beta Blockers
Calcium Channel Blockers
You must treat the underlying cause --> administer statins and prevent thrombus formation --> aspirin
Term
Name 4 organic nitrates
Definition
amyl nitrate
glyceryl nitrate
isosorbide dinitrate
isosorbide mononitrate
Term
Indications for nitrates?
5 things
Definition
termination of acute anginal attack**
Prophylaxis for stress induced attacks
pts w/ frequent symptoms
pts who cannot take Beta blockers or Ca channel blockers
treatment of cyanide poisoning
Term
Nitrate MOA?
Definition
Exogenous nitrates or NO -> increase in guanyl cyclase -> increase cGMP -> smooth muscle relaxation -> vascular dilation
reduce myocardial O2 consumption via reduced work load through venodilation and arteriole dilation.
Increase O2 supply via dilation of collateral circulations.
Inhibits platelet aggregation via inhibition of thromboxane synthetase.
Term
Side effects w/ nitrates
Definition
flushing nausea
Throbbing headace (meningeal artery vasodilation)
orthostatic hypotension
reflex tachycardia (combine w/ beta blocker to prevent)
syncope, dizziness
high doses -> methemoglobinemia
Term
How do you decrease or avoid Nitrate side effects and tolerance?
Definition
by providing a nitrate fee period such as not taking the drugs before bedtime
Term
contraindications to administering nitrates
Definition
pt on migraine medication or if they are taking other vasodilators such as viagra or other PDE5 inhibitors.
Term
What is the nitrate of choice for quick relief during exertion?
Definition
sublingual tablets or sprays
Term
When are the longer acting nitrates indicated and what are they?
Definition
ISDN and ISMN are indicated when symptoms become more frequent and severe.
Term
What is the main way that Beta blockers relieve stable angina?
Definition
by decreasing cardiac workload and o2 demand via stopping increases in heart rate and contractility
Term
Why would you combine nitrates w/ beta blockers?
Definition
to reduce the reflex tachycardia associated w/ nitrates
Term
Side effects of beta blockers
Definition
bronchospasm, bradycardia, fatigue, depression, rebound hypertension
Term
Name the three classes of L-type Ca channel blockers and examples of each?
Which specific channels do each class block?
Definition
Dihydropyridines block vascular Ca channels: nifedipine and beperidil
Phenylalkylamines block cardiac Ca channels: verapamil
Benzothiazapines block both vascular and cardiac Ca channels: Diltiazem
Term
is it ok to combine beta blockers w/ Ca channel blockers?
Definition
No
Term
Is it ok to combine Nitrates and calcium channel blockers?
Definition
yes
Term
4 other uses for calcium channel blockers?
Definition
PSVT, Reynauds syndrome, Migraines, Strokes
Term
What is the number 1 choice in relieving an acute variable angina attack?
Definition
nefedipine - relieves the coronary vasospasm
Term
Side effects of nefedipine?
Definition
headache, constipation (all Ca blockers), and gingival hyperplasia
Term
What is the difference between Beperidil and Nefedipine?
Definition
bepiridil (vascor) also blocks Na channels
Term
Side effects of beperidil?
Definition
if combined w/ Beta blockers -> heart failure
Torsades or other arrythmias
Agranulocytosis
Term
Indications to use a phenylalkylamine?
Definition
stable or variant angina.
Term
Verapamil drug class and effects?
Definition
classed as a pheylalkylamine and decreases cardiac workload via slowing heart rate (slows AV conduction) and contractility.
Term
Side effects of verapamil?
Definition
constipation and gingival hyperplasia.
Sinus bradycardia.
Term
Indications for Diltiazem administration?
Definition
Stable or Variant angina
Term
Side effects of benzothiazapines?
Definition
diltiazem
Sinus bradycardia, AV block (if used w/ beta blockers), hypotension, edema
Term
Name 8 side effects associated w/ all calcium channel blockers
Definition
1. constipation 2. gingival hyperplasia 3. heart failure w/ beta blockers 4. bradycardia 5. nausae/flushing 6. edema 7. reflex tachycardia 8. dizzines
Term
Are beta blockers indicated in the treatment of variant angina?
Definition
No.
Term
treatment choice in management of unstable angina?
Definition
first of all, if they have ST segment changes, consider angioplasty
drugs of choice are beta-blockers w/ nitrates + anti-coagulants.
Term
Post ACS, what drug is most indicated?
Definition
beta blockers. specifically B1 blockers
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