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AntianginalDrugs
lecture 13 mumby
| Question | Answer |
|---|---|
| aim of antianginal tx | either to inc O2 supply by inc/redistributing coronary blood flow or reduce O2 demand by lowering HR, contractility or wall tension |
| beta blocker effects in context of angina | reduce O2 deman by dec HR, contractility and wall tension; may inc O2 supply by allow subendocardium to get more blood b/c diastole is lengthened |
| when not to use beta blockers | asthmatic pts, acute heart failure, variant angina, SA or AV node dz |
| therapeutic uses of beta blockers | in stable or unstable angina, espcially post-MI period; may be used in combo with nitrate and Ca++ channel blockers |
| verapamil and diltiazem | arterial SM cell vasodilators (less potent than the DHPs), modest dec in contractility. dilt = dec conduction through AV node and dec automaticity of SA node = neg inotropy |
| nifedipine and DHP drugs | all drugs ending in -pine, increase O2 supply - very potent vasodilators that can cause reflex tachy and inc contractility, reduce O2 demand (less LV afterload) |
| mechanism of Ca++ channel blockers | bind L-type channels in SM cells to reduce entry. diltiazem and verapamil bind domains that make for slow recovery and cause direct (-) chronotropic and inotropic effects |
| nitrates | work by inc intracellular NO = uptake of SR Ca++ and relaxation/dilation of peripheral venules (some arterial) = dec LV preload with mild reflex tachy. @ high doses, can dilate epicardial vessels to lessen effects of stenosis |
| NTG | short duration of action (20-30 min), SL, IV and oral preps work rapidly, topical work more slowly |
| isosorbide dinitrate | SL and oral tabs works longer than regular NTG, sustained antianginal/hemodynamic effects. half-life 45 min |
| adverse effects of nitrates | H/A from menigeal vessel dilation, vertigo, dizziness, flushing, postural HTN |
| nitrate tolerance | for unk reason body develops tolerance to nitrates over time. recommended 8-12 hr nitrate-free interval each day |
| cross-interaction with PDE5 inhibitors | PDE-5 breaks down cGMP, blockers prolong effects of NO. when used with nitrates can precipitate dangerous hypotensive episode, retinal disturbances exacerbated |
Created by:
sirprakes
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