chapter 27: Antianginal drugs
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| what are the three classes of antianginal drugs? | nitrates, beta blockers, CCB
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| nitroglycerine is what class of anti anginal drug? | nitrate.
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| nitroglycerin is the DOC for... | prompt relief of antina due to exertion or emotional stress (stable angina).
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| does nitroglycerin have extensive first pass effect? | yes, why the sublingual route is preferred.
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| what are the drugs of choice for acute presentation of chest pain of suspected cardiac origin? | sublingual nitroglycerin plus oxyggen plus aspirin (+/- morphine)
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| all nitrates act to cause.. | vasodilation. by causing venodilation, they reduce the vlume of blood returned to the heart (preload), the amount of blood the heart has to pump is decreased.
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| do nitrates affect vasodiilation of arteries or veins more? | veins, but they affect both
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| effect of arterial vasodilation by nitroglycerin? | decreases peripheral vascular resistance, increases blood perfusion to the heart. decreasing afterload (decreasing the resistnace against which the heart must pump blood). heart works less.
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| onset of action of nitroglycerin in sublingual form? | one minute
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| besides sublingual form, what are some other forms of nitroglycerin administration? | nitroglycerin ointment, sustained release tablets, transdermal patch, IV
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| what are the drugs of choice for acute MI and unstable angina? | IV nitroglycerin, aspirin, oxygen, morphine, heparin, beta blockers
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| nitrates are contraindicated in which individuals | whoa re hypotensive (anyone with systolic blood pressure <90 mmHg), who have severe bradycardia, who have tachycardia, or in those with a right ventricular MI, and in indivdiduals who receive erectile dysfunction therapy w/I past 24-48hrs
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| common side effect of notroglycerine? | hadache
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| this is another nitrate. it is not readily metabolized by the liver, so can effectively be given orally. onset is greater than one hour, therfore not used for acute events. used for chronic maintenance | isosorbide dinitrate
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| this class of drugs block calcium entry into cardiac and smooth muscle cells of arterioles, inhibiting contraction. | calcium channel blockers
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| example of CCB? | nifedipine
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| CCBs primarily affect which muscle? | smooth muscle in the peripheral vasculature (specifically, in arterioles), with little to no effect on the heart.
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| with CCB, what does decreased peripheral vascular resistance do to the heart? | decreases afterload, allows hear tot pump against less pressure, allowing it to work less.
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| this is a CCB that affects primarily the heart with also some significant vasculature effect. | verapimil. due to its heart effect, it causes the heart to work less.
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| can ccbs be used for daily antianginal therapy? | yes
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| what is the DOC for diagnosed printzmetals angina? | CCBs
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| what beta blockers may be used for angina? | propanolol, metoprolol.
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| MOA of BBs? | they decrease the work of the heart by blocking beta receptors, thus decreasing oxygen demand.
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| are BB used for acute angina? | no, but can be used for daily antianginal therapy. they are alos part of standard therapy in acute unstable angina and MI.
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