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Questions and Answers
What is a primary effect of beta-blockers on the cardiovascular system?
What is a primary effect of beta-blockers on the cardiovascular system?
- Increase arterial blood pressure
- Enhance oxygen demand during exertion
- Decrease heart rate and myocardial contractility (correct)
- Increase myocardial contractility
In which condition are beta-blockers contraindicated due to the potential for inducing coronary spasm?
In which condition are beta-blockers contraindicated due to the potential for inducing coronary spasm?
- Variant or Prinzmetal angina (correct)
- Acute myocardial infarction
- Stable angina
- Heart failure
What is the primary effect of beta blockers in the management of angina?
What is the primary effect of beta blockers in the management of angina?
- Inhibits platelet aggregation
- Decreases heart rate and myocardial contractility (correct)
- Dilates coronary arteries
- Increases myocardial oxygen demand
Which mechanism describes how nitrates relieve angina symptoms?
Which mechanism describes how nitrates relieve angina symptoms?
Which of the following statements regarding the mechanism of Ivabradine is correct?
Which of the following statements regarding the mechanism of Ivabradine is correct?
What potential risk is associated with the sudden cessation of beta-blocker therapy?
What potential risk is associated with the sudden cessation of beta-blocker therapy?
What is the action of calcium channel blockers in the context of angina?
What is the action of calcium channel blockers in the context of angina?
Which of the following antiplatelet agents works by irreversibly inhibiting the P2Y12 receptor on platelets?
Which of the following antiplatelet agents works by irreversibly inhibiting the P2Y12 receptor on platelets?
What is the effect of Ranolazine on cardiac function?
What is the effect of Ranolazine on cardiac function?
Which antiplatelet agent is primarily used as a first-line treatment for acute coronary syndrome?
Which antiplatelet agent is primarily used as a first-line treatment for acute coronary syndrome?
What is the primary mechanism of action of nitrates in treating angina?
What is the primary mechanism of action of nitrates in treating angina?
Which of the following drugs is primarily used in treating Prinzmetal angina?
Which of the following drugs is primarily used in treating Prinzmetal angina?
Which drug interaction is particularly dangerous when using nitrates?
Which drug interaction is particularly dangerous when using nitrates?
What side effect is associated with the development of tolerance during nitrate therapy?
What side effect is associated with the development of tolerance during nitrate therapy?
What is the main therapeutic effect of beta-blockers in the management of angina?
What is the main therapeutic effect of beta-blockers in the management of angina?
Which route of administration is NOT available for Nitroglycerin?
Which route of administration is NOT available for Nitroglycerin?
Which nitrate is specifically mentioned as being available as an inhalational form?
Which nitrate is specifically mentioned as being available as an inhalational form?
What is a key characteristic of non-dihydropyridine calcium channel blockers in angina treatment?
What is a key characteristic of non-dihydropyridine calcium channel blockers in angina treatment?
Study Notes
Miscellaneous Agents
- Ranolazine: Inhibits late sodium current, facilitating calcium entry via sodium-calcium exchanger, increases myocardial stress and oxygen demand.
- Trimetazidine: Inhibits ketoacyl coA thiolase, improving energy production efficiency by favoring glucose oxidation over fatty acids, which consumes less O2.
- Antiplatelet Agents: Include Aspirin, Ticlopidine, Clopidogrel, used primarily for preventing thrombosis.
Beta-Blockers
- Common Beta-Blockers: Propranolol, Metoprolol, Atenolol, Nadolol, Timolol, Acebutolol, Betaxolol, Bisoprolol, Esmolol, Labetalol.
- Mechanism: Reduces oxygen demand by lowering heart rate and myocardial contractility, leading to decreased arterial blood pressure.
- Uses: Effective in treating typical angina by preventing exercise-induced attacks and managing reflex tachycardia.
- Acute Myocardial Infarction: Helps decrease recurrence rates and improve survival.
- Contraindications: Not recommended for Variant or Prinzmetal Angina; may mask hypoglycemia in diabetic patients on strict insulin therapy.
- Withdrawal Concerns: Sudden discontinuation can cause withdrawal syndrome, potentially exacerbating angina or causing myocardial infarction.
Ivabradine
- Mechanism of Action: Selectively inhibits the funny channel pacemaker current (If) in the sinoatrial node, lowering heart rate and increasing coronary perfusion time.
- Indications: Beneficial in chronic angina and heart failure treatment.
Nitrates & Nitrites
- Mechanism of Action: Nitric oxide activates guanylyl cyclase, increasing cGMP levels, resulting in vasodilation.
- Common Agents: Include Nitroglycerin (oral, sublingual, IV, topical), Isosorbide Dinitrate (sublingual, MR tablets), Erythritol Tetranitrate, Pentaerythritol Tetranitrate, Amyl Nitrite (inhalational).
- Side Effects: Include reflex tachycardia, transient throbbing headache, and Monday disease (tolerance development).
- Indications: Primarily used for stable angina, acute attacks (sublingual or IV), and prophylaxis via oral tablets or patches. Intravenous nitroglycerin is critical for unstable angina treatment.
- Combination Therapy: Nitrates with beta-blockers shown to be more effective than either monotherapy.
Drug Interactions
- Nitrates + Sildenafil (Viagra®): Risk of excessive vasodilation leading to potential fatal outcomes due to increased cGMP levels.
Calcium Channel Blockers
- Mechanism: Dihydropyridines (DHPs) reduce afterload by relaxing arteries; non-DHPs lower heart rate and contractility, decreasing oxygen demand.
- Use Case: Particularly effective and considered the drug of choice for Prinzmetal angina.
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