Antianginal Drugs and Angina Pectoris
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Questions and Answers

What is the main component of the fatty deposits known as plaque in coronary arteries?

  • Triglycerides
  • Cholesterol (correct)
  • Phospholipids
  • Saturated fats

Which type of angina pectoris is characterized by unpredictability and can occur at rest?

  • Episodic angina
  • Chronic stable angina
  • Variant angina (correct)
  • Stable angina

What is the primary goal of treating coronary artery disease (CAD)?

  • Eliminate all forms of exercise
  • Increase blood cholesterol levels
  • Enhance appetite for fatty foods
  • Reduce the number and severity of anginal attacks (correct)

A complete blockage of one or more coronary arteries can lead to what serious condition?

<p>Myocardial infarction (C)</p> Signup and view all the answers

Which of the following is NOT one of the three classes of drugs used to treat angina pectoris?

<p>Anticoagulants (D)</p> Signup and view all the answers

What lifestyle change is emphasized for the management of coronary artery disease?

<p>Weight control (C)</p> Signup and view all the answers

What commonly triggers exertional angina?

<p>Emotional stress and physical exertion (D)</p> Signup and view all the answers

What is the term used to describe the reduced blood flow to the heart muscle due to narrowed coronary arteries?

<p>Ischemia (C)</p> Signup and view all the answers

What is the primary therapeutic action of nitrates during an angina attack?

<p>Produce systemic vasodilation (C)</p> Signup and view all the answers

What risk is associated with unstable angina due to nearly complete blockage of coronary arteries?

<p>Activation of blood platelets (B)</p> Signup and view all the answers

Which of the following correctly describes the mechanism of action of nitrates?

<p>Convert to nitric oxide to relax vascular smooth muscle (C)</p> Signup and view all the answers

Why do nitrates have a limited effect on atherosclerotic coronary arteries during angina?

<p>Coronary arteries are cumulatively maximally dilated during ischemia (C)</p> Signup and view all the answers

What is the primary route of administration for nitrates during an acute angina episode?

<p>Sublingual application (B)</p> Signup and view all the answers

What physiological effects does venodilation produced by nitrates lead to?

<p>Decreased venous return and afterload (B)</p> Signup and view all the answers

In addition to nitrates, what type of treatment is critical for managing unstable angina?

<p>Aggressive therapy with anticoagulants (D)</p> Signup and view all the answers

What are the two primary uses of nitrates in relation to angina?

<p>Immediate relief during attacks and daily prophylactic use (C)</p> Signup and view all the answers

What precaution should patients using a transdermal patch for nitroglycerin take during sleep?

<p>Remove the patch to avoid excessive drug absorption. (D)</p> Signup and view all the answers

Which condition necessitates the use of intravenous nitroglycerin?

<p>Emergency and surgical situations. (B)</p> Signup and view all the answers

Which side effect is NOT commonly associated with the use of nitrates?

<p>Blurred vision (C)</p> Signup and view all the answers

What instruction should be given to patients experiencing chest pain from angina?

<p>Place the nitroglycerin tablet under the tongue and lie down. (B)</p> Signup and view all the answers

Why is it important to carry nitroglycerin tablets in light-resistant, airtight containers?

<p>To prevent loss of potency due to environmental exposure. (D)</p> Signup and view all the answers

What should patients do if they do not experience relief after taking three nitroglycerin tablets?

<p>Notify a physician or seek immediate medical assistance. (D)</p> Signup and view all the answers

What is the interaction between nitrates and certain erectile dysfunction medications?

<p>It causes an immediate drop in blood pressure. (A)</p> Signup and view all the answers

What should patients be aware of regarding the activities that may trigger angina?

<p>Emotional upset, overeating, and overexertion are common triggers to avoid. (C)</p> Signup and view all the answers

What is the primary mechanism by which nitrates relieve anginal pain?

<p>Decreasing the oxygen requirement of the heart (D)</p> Signup and view all the answers

Which form of nitroglycerin provides the fastest relief for acute angina attacks?

<p>Sublingual tablets or spray (B)</p> Signup and view all the answers

What is the expected duration of action for nitroglycerin administered as an ointment?

<p>4 to 8 hours (D)</p> Signup and view all the answers

What is the significance of a drug-free period when using nitrates?

<p>It prevents tolerance to the drug from developing. (D)</p> Signup and view all the answers

Which of the following nitroglycerin products releases the drug over a 24-hour period?

<p>Transdermal patch (C)</p> Signup and view all the answers

What is a commonly used therapeutic purpose of nitroglycerin extended-release capsules?

<p>To prevent anginal attacks (prophylaxis) (C)</p> Signup and view all the answers

How does sublingual administration of nitroglycerin avoid first-pass metabolism?

<p>By delivering the drug directly to the bloodstream (B)</p> Signup and view all the answers

Each inch of nitroglycerin ointment contains approximately how much nitroglycerin?

<p>15 mg (A)</p> Signup and view all the answers

What is the primary mechanism through which calcium channel blockers relieve angina?

<p>Decrease vascular smooth muscle contraction by preventing calcium influx (D)</p> Signup and view all the answers

Which of the following statements about diltiazem is correct?

<p>It has greater vasodilating actions compared to verapamil. (A)</p> Signup and view all the answers

What is the main cardiovascular effect of verapamil during angina treatment?

<p>Decrease in heart rate and myocardial contraction force (B)</p> Signup and view all the answers

In the context of variant or Prinzmetal angina, which statement is accurate about calcium channel blockers?

<p>They are the preferred treatment option for this condition. (B)</p> Signup and view all the answers

Which of the following is a key effect of arterial vasodilation from calcium channel blockers?

<p>Reduction of afterload (C)</p> Signup and view all the answers

What potential risk is associated with excessive use of verapamil in heart function?

<p>Precipitation of heart failure (B)</p> Signup and view all the answers

How do dihydropyridine calcium channel blockers primarily function compared to verapamil and diltiazem?

<p>They are potent vasodilators with minimal effects on the heart. (B)</p> Signup and view all the answers

What is a notable side effect of verapamil among calcium antagonists?

<p>Constipation (C)</p> Signup and view all the answers

Which calcium antagonist is primarily known for causing bradycardia with overdosage?

<p>Verapamil (D)</p> Signup and view all the answers

What is the primary pharmacological effect shared by nicardipine and nifedipine?

<p>Vasodilation (C)</p> Signup and view all the answers

What must be avoided when using verapamil or diltiazem alongside beta-blockers?

<p>Excessive cardiac depression (C)</p> Signup and view all the answers

What is a critical management strategy for patients experiencing variant or Prinzmetal angina?

<p>Drug-free interval when using nitrates (D)</p> Signup and view all the answers

Which type of angina is best treated with calcium channel blockers due to its major feature of vasospasm?

<p>Variant or Prinzmetal angina (C)</p> Signup and view all the answers

Flashcards

Coronary Artery Disease (CAD)

A condition caused by atherosclerosis, reducing coronary blood flow, leading to angina pectoris.

Atherosclerosis

Fatty build-up (plaque) in coronary arteries, reducing blood flow.

Angina Pectoris

Chest pain caused by insufficient blood flow to the heart muscle (myocardium).

Exertional Angina

Angina triggered by activity, stress, or exertion.

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Variant (Prinzmetal) Angina

Angina caused by coronary artery spasm, unpredictable and can occur at any time.

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Myocardial Infarction (MI)

Heart attack; complete blockage of a coronary artery.

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Ischemia

Reduced blood flow to the tissues.

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Coronary Arteries

The arteries that supply blood to the heart muscle.

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Sublingual Nitroglycerin

A nitroglycerin form taken under the tongue to treat acute angina attacks.

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Nitroglycerin Ointment

Topical application for angina prevention. Effective for 4-8 hrs.

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Extended-Release Capsules

Sustained-release nitroglycerin used daily to prevent anginal attacks.

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Transdermal Nitroglycerin

Slow, continuous release of nitroglycerin through an adhesive patch.

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Nitrate drugs

Medication used to treat angina and CAD by reducing cardiac workload.

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Angina

Chest pain caused by reduced blood flow to the heart.

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First-pass metabolism

Breakdown of a drug by the liver before it reaches the bloodstream.

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Drug Tolerance

Reduced effectiveness of a drug after continuous use, especially with nitrates.

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Angina treatment

Treatment for angina involves drugs to relax arterial smooth muscle, dilate arterioles, and prevent blood clots. Aggressive therapy with anti-anginals, anticoagulants, and antiplatelets is crucial, along with procedures like angioplasty and bypass.

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Nitrates in angina

Nitrates primarily cause vasodilation of systemic veins and arteries, reducing venous return, cardiac work, and oxygen consumption. This relief ischemia and pain.

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Nitrates mechanism

Nitrate drugs relax vascular smooth muscle via nitric oxide (NO). NO is made from nitrate ions released from the drug. Venous dilation is stronger than arterial at low doses.

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Nitrate administration

Nitrates are administered during angina attacks (sublingually) for immediate pain relief, and prophylactically daily to prevent attacks.

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Unstable angina

A serious angina type linked to advanced coronary artery disease, where arteries are nearly blocked, increasing risk of clot formation and myocardial infarction.

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Coronary artery blockage

Complete coronary blockage can lead to platelet activation, clot formation, and myocardial infarction (heart attack).

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Vasospasm relief

Drugs that relax arterial smooth muscles and produce arteriolar dilation effectively relieve vasospasm (constriction of blood vessels).

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Ischemia and vasodilation

Ischemia is a potent vasodilator during an angina attack. Coronary arteries are maximally dilated even before nitrate treatment

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Nitroglycerin Patch - Nighttime Removal

Transdermal nitroglycerin patches should be removed at night during sleep to avoid potential side effects.

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IV Nitroglycerin - Duration of Action

Intravenously administered nitroglycerin acts quickly but has a short duration of effect.

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Nitroglycerin - Main Side Effects

The primary side effects of nitrates are due to their vasodilating action, leading to flushing, dizziness, headache, weakness, and fainting.

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Angina Attacks - Medication

Patients should carry their prescribed nitroglycerin at all times to manage unpredictable angina attacks.

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Nitroglycerin Tablets - Storage

Nitroglycerin tablets are sensitive to light and air, requiring storage in airtight, light-resistant containers.

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Nitroglycerin Tablets - Expiration

Do not use nitroglycerin tablets that are more than 6 months old, as potency can significantly decrease.

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Nitroglycerin - Administration

When experiencing angina, sit down, place a tablet under the tongue, and allow it to dissolve without swallowing.

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Nitroglycerin - Side Effects Management

Patients should be aware of common side effects (flushing, headache, dizziness) and advised to lie down if they feel faint.

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Calcium Channel Blockers

Drugs that block calcium channels in the heart and blood vessels, leading to relaxation of smooth muscle and reduced blood pressure.

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Variant Angina

Chest pain caused by spasms in coronary arteries, occurring unpredictably.

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Afterload

The resistance the heart pumps against during contraction, affected by blood pressure and vascular tone. Calcium channel blockers reduce afterload.

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Verapamil & Diltiazem Action

These calcium channel blockers reduce heart rate, conduction speed, and the force of heart contractions, in addition to vasodilation.

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Nifedipine Action

This calcium channel blocker primarily dilates arteries, affecting blood pressure and coronary artery spasm.

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Calcium Channel Blockers & Heart Function

Some calcium channel blockers (verapamil, diltiazem) can also affect the heart, while others (nifedipine) mainly target blood vessels.

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Calcium Channel Blockers: Daily Use

Calcium channel blockers are commonly prescribed daily to prevent angina episodes and treat variant angina.

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Nicardipine (Cardene)

A calcium channel blocker similar to nifedipine; primarily used to dilate arteries and relax coronary artery spasms.

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Calcium Channel Blockers (CCBs)

Drugs that block calcium channels in smooth muscle cells, leading to vasodilation and relaxation of blood vessels.

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Amlodipine (Norvasc)

A long-acting calcium channel blocker primarily used for hypertension, also effective for angina.

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Felodipine (Plendil)

A calcium channel blocker similar to nifedipine, with a long duration of action.

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Isradipine (DynaCirc)

A calcium channel blocker primarily used for hypertension, with a shorter duration of action than amlodipine.

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Verapamil

A calcium channel blocker that can cause constipation as a side effect.

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Diltiazem

A calcium channel blocker that can cause bradycardia, AV block, and heart failure in overdose.

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Reflex Tachycardia

An increased heart rate that occurs as a reflex response to a drop in blood pressure.

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Study Notes

Antianginal Drugs

  • Coronary arteries branch off the aorta, delivering blood to the myocardium.
  • Coronary arteries are susceptible to plaque formation, mainly cholesterol.
  • Atherosclerosis, fatty degeneration of coronary arteries, reduces blood flow, causing ischemia.
  • Coronary artery disease (CAD) results from atherosclerosis and ischemia.
  • Angina pectoris is chest pain due to insufficient blood flow to the myocardium.
  • Myocardial infarction (MI), or heart attack, occurs from complete blockage of one or more coronary arteries.

Classification of Angina Pectoris

  • Exertional angina is predictable, caused by insufficient coronary blood flow due to atherosclerotic plaques.
  • Variant/Prinzmetal angina is unpredictable, caused by coronary artery vasospasm.
  • Unstable angina is a serious condition with advanced CAD, possibly leading to a blood clot and MI.

Nitrates

  • Nitrates were once considered coronary dilators, but are ineffective in hardened arteries (atherosclerosis).
  • Nitrates produce general vasodilation of veins and arteries, reducing venous return, cardiac work, and oxygen consumption.
  • Nitrates are administered sublingually (under the tongue) during attacks for immediate relief or prophylactically daily.
  • Sublingual administration avoids first-pass metabolism by the liver, providing faster relief.

Mechanism of Action

  • Nitrates relax vascular smooth muscle by converting to nitric oxide, a potent vasodilator.
  • Venodilation is greater than arteriolar dilation in lower doses.
  • Reduced venous return, cardiac work, and oxygen demand leads to pain relief and reduced ischemia.

Clinical Use of Nitrate Drugs

  • Nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate are available in various forms for angina and CAD.
  • Sublingual nitroglycerin tablets or sprays dissolve rapidly, providing immediate pain relief.
  • Topical nitroglycerin ointment and extended-release capsules provide prolonged effects, preventing attacks.
  • Transdermal nitroglycerin patches provide continuous release over 24 hours.

Nitroglycerin for Intravenous Infusion

  • IV nitroglycerin is used in emergencies for rapid onset, but short duration of effect.

Adverse Effects

  • Common adverse effects include headache, dizziness, weakness, and fainting, which are due to vasodilation.
  • The effects decrease blood pressure, causing reflex tachycardia.

Beta-Adrenergic Blocking Drugs

  • Beta-blockers counteract sympathetic activation, preventing increased heart rate, force of contraction, and oxygen consumption during exertion and stress.
  • This is effective in decreasing cardiac work and oxygen demand, preventing ischemia and pain.
  • Common adverse effects are drowsiness, tiredness, nausea, diarrhea, and potentially bradycardia, hypotension, and heart failure.
  • Non-selective beta-blockers can cause bronchoconstriction and should not be used for patients with asthma or COPD.

Calcium Channel Blockers

  • Calcium channel blockers prevent calcium influx into vascular smooth muscle, reducing contraction and promoting vasodilation.
  • This decreases cardiac work and oxygen consumption.
  • Primarily daily use to prevent angina.
  • Effective in relieving vasospasm (e.g., in variant angina).
  • Some calcium channel blockers also affect cardiac muscle, reducing heart rate and AV conduction.

Calcium Channel Blockers with Direct Cardiac Effects

  • Verapamil and diltiazem directly affect cardiac function, decreasing heart rate, AV conduction, and myocardial contractility.
  • These properties can be beneficial in angina, but can also cause excessive cardiac depression leading to heart failure.

Calcium Channel Blockers Without Direct Cardiac Effects

  • Nifedipine and other related compounds, primarily dilate arteries without a direct cardiac effect.
  • These agents are less likely to cause excessive heart depression, but can have reflex tachycardia.
  • Combination with beta-blockers can lead to excessive cardiac depression and heart failure should be avoided.

Preferred Therapy for Angina Pectoris

  • Sublingual nitrates are used for immediate relief.
  • Nitrates, beta-blockers, and calcium channel blockers are effective for exertional angina.
  • The choice depends on coexisting medical conditions, and combination therapy can be adjusted based on patient response.
  • Vasospasm of variant angina is best treated with calcium channel blockers.

Unstable Angina

  • Patients with unstable angina risk MI.
  • Antiplatelet and anticoagulants are essential to prevent clot formation.
  • Interventions such as coronary bypass grafting or percutaneous coronary interventions are considered in patients with unstable angina.

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Antianginal Drugs PDF

Description

This quiz covers the fundamental concepts of antianginal drugs and their role in treating angina pectoris. It includes information on coronary artery disease, types of angina, and the mechanism of nitrates. Test your understanding of how these drugs affect myocardial blood flow and their application in different scenarios.

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