Pharm - angina pectoris
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| types of angina (not unstable which requires hospitalization) | chronic stable/most common=exertional ----variant/Prinzmetal's = vasospastic/idiosyncrastic
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| what goes wrong in angina | too little 02 supply ---too much 02 demand
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| class of drugs that treat angina | nitrates---beta blockers---calcium channel blockers---stand alone ranolazine
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| what types of angina do nitrates treat | stable and variant treated by this class
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| MOA of nitrates | ECF nitrate ---VSM nitrate ---converted to nitric oxide by sulfonyl group enzymes (which must not be depleted)---NO is a vasoDIL which leads to venous dilation(dec preload)---and---arterial dilation (dec preload, dec coronary vasospasm)
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| nitrates are poster boy for this drug response | tachyphylaxis - sudden, immediate decrease in drug response
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| ADRs nitrates | HA bwo vasodil---ORTHOSTATIC hypoTN---reflex tachy (to compensate for vasodil)---usually concurrent admin of BB or CCB to blunt this effect
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| nitrate patch must be removed for 6-8 hours. why | so we don't deplete the sulfonyl group enzymes which could lead to tolerance to efficacy
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| nitrates CONTRAINDICATED for this class | PDE-5 inhibitors, which are potent vasoDIL = sildenafil, tadalafil, vardenafil
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| quick-short nitrate | sublingual tab, sublingual spray
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| quick-long nitrate | transmucosal tab
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| slow-long nitrate | patch MUST BE REMOVED 6-8h to preserve sulfonyl groups on enzyme----ointment, ISMN tab
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| quick-long | ISDN = isosorbide DInitrate---sublingual, chewable, tab/cap
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| Beta blockers treat what type of angina | only treat exertional/stable. they have no vasoDIL effects----work to decrease 02 demand bwo ---dec HR, CO & afterload
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| what do we need to watch for with BBs and asthma pts | watch for asthmatic effect if BB is non-selective (propanolol, naldolol, timolol)
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| what type of angina does CCBs treat | both stable/chronic---variant---decreases 02 demands AND vasodilates
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| examples of CCBs | verapamil/diltiazem-----amlodipine & all dipine's in class
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| both CCBs and BBs have similar SEs which are | cardiac effects = dec HR, AV block, dec contractility, dec bp, reflex tachy
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| what is one stand alone drug whose MOA is opposit of digoxin | ranolazine ----MOA is to decrease late Na current, keeping Ca from getting too high in cell---> decreased cardiac work--->improve supply/demand balance
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| ranolazine ADRs | prodysrhythmic/TdeP---dizz/HA/c/n
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| what drug lease likely to need 8 hour free period? | any short acting nitrate (any non-patch, really)
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| what drug least likely to help Prinzmetals/variant angina | BBs because they do not vasodilate
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| what drug least likely to be 1st line drug | ranolazine - prevention, too new with prodysrhythmic ADR
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| standard order of drug admin for angina is nitrate---BB---CCB---long acting nitrate. what if pt is asthmatic? | then we would use CCB as 2nd agent
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