Angina Pectoris Overview

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Questions and Answers

What condition is Viagra primarily used to treat?

Hypertension

Heart failure

Chronic angina

Erectile dysfunction (correct)

What serious interaction should be considered when combining nitrates with certain medications?

QT prolongation

Synergistic hypotension (correct)

Increased heart rate

Decreased oxygen supply

What is the primary mechanism of action for beta blockers?

Enhancing nitric oxide production

Stimulating vasodilation

Inhibiting norepinephrine at receptors (correct)

Increasing heart rate

Which of the following is a known effect of phosphodiesterase 5 inhibitors?

QT prolongation Signup and view all the answers

Ranolazine is primarily used in the treatment of which condition?

Chronic angina Signup and view all the answers

Which type of angina is commonly known as effort-induced angina?

Stable Angina Signup and view all the answers

What is a characteristic feature of angina pectoris?

Severe sudden constricting substernal pain Signup and view all the answers

What physiological change causes stable angina?

Increased oxygen demand Signup and view all the answers

Which of the following symptoms is NOT typically associated with angina pectoris?

Euphoria Signup and view all the answers

Which condition can lead to the accumulation of acidic metabolites that cause angina?

Obstruction due to plaques in coronary arteries Signup and view all the answers

What is a primary mechanism of action for nitrates in the treatment of angina pectoris?

Vasodilation of coronary vessels Signup and view all the answers

Which of the following is NOT a common adverse drug reaction (ADR) associated with nitrates?

Hyperglycemia Signup and view all the answers

What condition may worsen with the use of nitrates in patients with chronic heart failure (CHF)?

Congestive symptoms Signup and view all the answers

Calcium channel blockers primarily perform which of the following functions?

Block calcium entry into smooth muscles Signup and view all the answers

What does 'Monday Disease' refer to in the context of nitrate use?

Tolerance build-up during the week Signup and view all the answers

What effect do nitrates have on myocardial fiber tension?

Decrease tension Signup and view all the answers

Which of the following symptoms is associated with methemoglobinemia due to nitrate use?

Cyanosis Signup and view all the answers

Which of the following is a therapeutic use of nitrates?

Relieving acute anginal attacks Signup and view all the answers

What is the primary effect of nitroglycerin in patients?

Increases blood flow and oxygen delivery Signup and view all the answers

Which of the following agents does NOT undergo first pass effect?

Isosorbide Mononitrate Signup and view all the answers

What is a major drug-drug interaction concern with calcium channel blockers (CCBs)?

CCBs with nitrates can cause additive vasodilation Signup and view all the answers

What is the half-life of Isosorbide Dinitrate (ISDN)?

40 minutes Signup and view all the answers

Which of the following agents is used specifically for the treatment of stable angina pectoris?

Nifedipine Signup and view all the answers

What effect does amyl nitrite have on the vascular system?

Increases vasodilation Signup and view all the answers

What is a potential side effect of sodium channel blockers?

Prolongation of the QT interval Signup and view all the answers

Which drug should be avoided with phosphodiesterase 5 inhibitors due to interactions?

Nitroglycerin Signup and view all the answers

Which class of drugs is known to improve diastolic function by reducing intracellular sodium?

Sodium channel blockers Signup and view all the answers

Which formulation of nitroglycerin is short acting?

Sublingual Signup and view all the answers

What distinguishes unstable angina from other types of angina?

Chest pain occurs with increased frequency and intensity Signup and view all the answers

Which of the following conditions is most likely to lead to angina?

Hypoxia state due to coronary artery disease Signup and view all the answers

What is the primary therapeutic strategy for managing angina?

Increase oxygen delivery and decrease requirement Signup and view all the answers

Which type of angina can occur without any physical activity?

Rest angina Signup and view all the answers

What is the main reason for chest pain in stable angina?

Coronary artery disease Signup and view all the answers

How long can angina typically last during an episode of unstable angina?

More than 20 minutes Signup and view all the answers

What action should be taken if a patient is experiencing angina and is unconscious?

Administer air to increase oxygen delivery Signup and view all the answers

What is a common precipitating event for angina episodes?

Participating in vigorous exercise Signup and view all the answers

In which condition are the myocardial cells already dead?

Infarction Signup and view all the answers

What is the primary mechanism of action for nitrates used in treating angina?

Dilate blood vessels and reduce myocardial oxygen demand Signup and view all the answers

Study Notes

Angina Pectoris

A spasmodic, cramp-like choking feeling characterized by severe, sudden, constricting substernal pain often radiating from the pericardium to the left shoulder down to the arm.
Decreased coronary perfusion due to atherosclerosis.
Pain can be relieved in 15 minutes of rest and by Nitroglycerin

Types of Angina Pectoris

Stable angina: Short-lasting, burning, heavy, or squeezing feeling in the chest. Associated with plaques that occlude coronaries.
Atypical angina: Patients can experience extreme fatigue, nausea or diaphoresis.
Silent angina: Not associated with any symptoms but there is chest pain.
Unstable angina (Crescendo angina): Chest pain occurs in increased frequency, duration and intensity. Can be precipitated by progressively less effort. Angina can last longer than 20 minutes. A form of acute coronary syndrome.
Rest angina (Prinzmetal angina, Variant angina, Vasoprastic angina): Pain can be felt at rest, due to coronary spasm causing decreased blood flow to the heart. Angina attacks are unrelated to physical activities, heart rate, or blood pressure. Responds to vasodilator or CCB.

Therapeutic Strategies

Increase oxygen delivery (if patient is conscious give water - if unconscious give air)
Decrease oxygen requirement (rest)
Increase efficiency of oxygen utilization

Anti-Anginal Drugs

Nitrites/Nitrates

MOA: Have direct relaxant effect on vascular smooth muscles and dilation of coronary vessels improving oxygen supply to the myocardium.
Effects: Vasodilation, (-) Inotropy (↓ Cardiac Force), ↓ myocardial fiber tension, ↓ oxygen requirement
Uses: Relief of acute anginal attacks, Prophylactic treatment, Long term management
ADR: Headache, Hypotension, Tachycardia, Methemoglobinemia, Monday disease

Beta Blockers

MOA: Inhibits NE in occupying the receptors, Causes (-) chronotropy (↓ HR), ↓ myocardial fiber tension
Uses: Prophylaxis of atherosclerotic angina, Prophylaxis of chronic angina together with nitrates
ADR: Worsen CHF, Bradycardia, Hypotension, Reduced blood flow, Edema

Calcium Channel Blockers

MOA: Blocks calcium entry into the smooth muscles, causes smooth muscle relaxation (vasodilation), faster blood flow to the myocardium (better delivery of oxygen/ oxygen demand on the body supplied). Causes QT prolongation.
Uses: Chronic angina, Used in patients who have failed in other anti-anginal drugs
Agent: Ranolazine

Phosphodiesterase 5 Inhibitors

Example: Sildenafil (Viagra)
Can result in synergistic hypotension with nitrates due to vasodilation.

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Description

This quiz covers the definition and types of angina pectoris, including stable, atypical, silent, unstable, and rest angina. You will learn about symptoms, causes, and relief measures such as rest and medication. Test your knowledge on this important cardiovascular condition.