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Mechanism of β-Blockers in Exertional Angina
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Mechanism of β-Blockers in Exertional Angina

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@CleanlyBoston

Questions and Answers

Which mechanism is primarily affected by pFOX inhibitors like trimetazidine?

  • Enhancement of fatty acid oxidation
  • Increase in oxygen consumption
  • Direct stimulation of myocardial oxygen supply
  • Partial inhibition of fatty acid oxidation (correct)

    • What is a significant outcome of reduced intracellular lactic acidosis due to pFOX inhibitors?

  • Increased oxygen demand of the myocardium
  • Increase in heart rate and blood pressure
  • Decrease in intracellular calcium and sodium accumulation (correct)
  • Enhanced coronary blood flow

    • In combination therapy, which other medications are pFOX inhibitors NOT typically paired with?

  • Antibiotics (correct)
  • Nitrates
  • β-blockers
  • Calcium channel blockers (CCBs)

    • Which statement regarding the effect of pFOX inhibitors on cardiac function is correct?

    <p>They have no effect on coronary blood flow.</p> Signup and view all the answers

    What is the primary treatment approach for symptomatic chronic heart failure patients with angina?

    <p>Amlodipine as the preferred CCB</p> Signup and view all the answers

    Which new anti-anginal drug is classified as a potassium channel opener?

    <p>Nicorandil</p> Signup and view all the answers

    What common characteristic describes newer options for treating chronic angina?

    <p>They adjust the balance between myocardial work and oxygen supply.</p> Signup and view all the answers

    Which of the following statements accurately reflects the role of new anti-anginal drugs?

    <p>They are controversial in their efficacy but approved for chronic stable angina.</p> Signup and view all the answers

    Which medication is least preferred for managing bronchial asthma?

    <p>Beta-blockers</p> Signup and view all the answers

    In the management of heart failure, which medication is considered most preferred?

    <p>Amlodipine</p> Signup and view all the answers

    What is a key manifestation of acute myocardial infarction (AMI)?

    <p>Severe chest pain</p> Signup and view all the answers

    Which class of medication is preferred for managing hypertension?

    <p>Beta-blockers</p> Signup and view all the answers

    What is the primary mechanism through which nicorandil exerts its effect?

    <p>It opens ATP-dependent K+ channels in vascular walls.</p> Signup and view all the answers

    For patients with diabetes mellitus, which medication is most preferable?

    <p>Nitrates</p> Signup and view all the answers

    Which of the following is a noted interaction when using nicorandil?

    <p>It should not be used with sildenafil.</p> Signup and view all the answers

    In acute myocardial infarction treatment, what is the treatment of choice for patients presenting within 12 hours of symptom onset?

    <p>Percutaneous coronary intervention</p> Signup and view all the answers

    What type of biochemical marker is indicative of myocardial cell death?

    <p>Troponin enzyme</p> Signup and view all the answers

    What effect does ranolazine have on intracellular calcium levels?

    <p>It decreases intracellular calcium indirectly by reducing sodium entry.</p> Signup and view all the answers

    What is a characteristic of the action of ranolazine?

    <p>It reduces cardiac contractility without affecting heart rate.</p> Signup and view all the answers

    Which option is NOT a common manifestation of acute myocardial infarction?

    <p>Pain relief after resting</p> Signup and view all the answers

    How does nicorandil's nitrate-like activity differ from traditional nitrates?

    <p>It has a significant nitrate component but with less marked tolerance effects.</p> Signup and view all the answers

    Which physiological parameter is notably unaffected by ranolazine?

    <p>Heart rate</p> Signup and view all the answers

    What should be considered when choosing an antianginal drug in patients with comorbid conditions?

    <p>The antianginal's impact on heart rate.</p> Signup and view all the answers

    Which of the following best describes the role of the late Na+ current in the action of ranolazine?

    <p>It decreases intracellular Na+ load, thereby reducing Ca2+ entry.</p> Signup and view all the answers

    What is the primary rationale for avoiding β-blockers with intrinsic sympathomimetic activity (ISA) in treating angina?

    <p>They exert minimal effect on heart rate and oxygen consumption.</p> Signup and view all the answers

    Why are β-blockers contraindicated in patients with Prinzmetal's angina?

    <p>They exacerbate coronary spasm by blocking β2-mediated dilation.</p> Signup and view all the answers

    Which of the following is a cytoprotective effect of β-blockers?

    <p>Reducing myocardial work by decreasing fat utilization.</p> Signup and view all the answers

    In the combination of β-blockers and nitrates, what effect does this have on heart rate?

    <p>Heart rate is decreased.</p> Signup and view all the answers

    Which class of drugs is considered first-line treatment for Prinzmetal's angina?

    <p>Calcium channel blockers.</p> Signup and view all the answers

    What is a common risk associated with short-acting dihydropyridine calcium channel blockers?

    <p>Increased risk of acute coronary syndrome (ACS).</p> Signup and view all the answers

    After β-blockers, which agent is typically considered as a second-line alternative for chronic stable angina?

    <p>Non-dihydropyridine calcium channel blockers.</p> Signup and view all the answers

    In the management of stable angina, how do calcium channel blockers primarily help?

    <p>By enhancing coronary blood flow and reducing myocardial oxygen demand.</p> Signup and view all the answers

    What is the primary purpose of administering morphine sulfate in a patient undergoing treatment for arterial occlusion?

    <p>To produce analgesia and reduce patient stress</p> Signup and view all the answers

    What is the role of ant coagulation drugs in managing patients with a history of myocardial infarction (MI)?

    <p>To prevent thrombus formation during treatment</p> Signup and view all the answers

    What is the main concern regarding routine oxygen administration in patients with arterial occlusion?

    <p>It has doubtful significance and does not reduce mortality</p> Signup and view all the answers

    Which pharmacological agent is primarily used to limit the size of myocardial infarction?

    <p>Beta-blockers</p> Signup and view all the answers

    What is the standard dosage of heparin given intravenously for anticoagulation in emergency situations?

    <p>10,000 IU</p> Signup and view all the answers

    Which of the following agents is NOT typically used as a thrombolytic therapy?

    <p>Beta-blockers</p> Signup and view all the answers

    What is the purpose of sedatives like diazepam in the context of treating patients with arterial occlusion?

    <p>To reduce anxiety and sedation</p> Signup and view all the answers

    Which physiological effect does morphine sulfate have that contributes to decreased cardiac workload?

    <p>Causes venodilation</p> Signup and view all the answers

    β-blockers are considered first-line treatment for Prinzmetal's angina.

    <p>False</p> Signup and view all the answers

    Long acting dihydropyridines are preferred over short acting ones for treating chronic stable angina.

    <p>True</p> Signup and view all the answers

    The combination of β-blockers and nitrates can result in an increased heart rate.

    <p>False</p> Signup and view all the answers

    Calcium channel blockers have a cytoprotective effect similar to β-blockers.

    <p>False</p> Signup and view all the answers

    β-blockers lead to an increase in diastolic filling time.

    <p>True</p> Signup and view all the answers

    Dihydropyridines should be avoided in patients experiencing acute coronary syndrome (ACS).

    <p>True</p> Signup and view all the answers

    Intrinsic sympathomimetic activity (ISA) in β-blockers is beneficial for heart rate reduction.

    <p>False</p> Signup and view all the answers

    CCBs are primarily used for their effect on contractility in chronic stable angina.

    <p>False</p> Signup and view all the answers

    Amlodipine is the preferred CCB for treating angina and hypertension in chronic heart failure patients.

    <p>True</p> Signup and view all the answers

    PFOX inhibitors increase intracellular lactic acidosis, leading to greater cell necrosis.

    <p>False</p> Signup and view all the answers

    The mechanism of action for pFOX inhibitors is based on enhancing fatty acid oxidation in the myocardium.

    <p>False</p> Signup and view all the answers

    Ranolazine is an example of a new anti-anginal drug that is particularly effective when used alone.

    <p>False</p> Signup and view all the answers

    The new anti-anginal drugs are primarily characterized by their ability to significantly increase heart rate.

    <p>False</p> Signup and view all the answers

    Potassium channel openers are considered traditional anti-anginal drugs and are often used alone.

    <p>False</p> Signup and view all the answers

    The efficacy of pFOX inhibitors in treating angina remains undisputed and universally accepted.

    <p>False</p> Signup and view all the answers

    PFOX inhibitors enhance myocardial oxygen supply by inhibiting carbohydrate utilization.

    <p>False</p> Signup and view all the answers

    Nicorandil opens ATP-dependent Na+ channels in the vascular wall leading to vasodilation.

    <p>False</p> Signup and view all the answers

    Ranolazine increases intracellular Ca2+ by enhancing the late Na+ current.

    <p>False</p> Signup and view all the answers

    The nitrate-like activity of nicorandil involves an increase in cGMP levels.

    <p>True</p> Signup and view all the answers

    Tolerance to the effects of nicorandil is marked compared to traditional nitrates.

    <p>False</p> Signup and view all the answers

    Ranolazine affects heart rate and blood pressure significantly.

    <p>False</p> Signup and view all the answers

    Sildenafil should be used cautiously in patients receiving therapy with nicorandil.

    <p>True</p> Signup and view all the answers

    Both potassium channel openers and nitrates are effective in treating all forms of angina.

    <p>False</p> Signup and view all the answers

    The mechanism of action of ranolazine does not involve modulation of intracellular sodium levels.

    <p>False</p> Signup and view all the answers

    In the management of bronchial asthma, beta-blockers are the most preferred medication.

    <p>False</p> Signup and view all the answers

    Amlodipine is the least preferred medication for treating heart failure.

    <p>False</p> Signup and view all the answers

    For hypertension management, nitrates are preferred over beta-blockers.

    <p>False</p> Signup and view all the answers

    Diabetes mellitus patients should primarily use nitrates and nifedipine over beta-blockers for treatment.

    <p>True</p> Signup and view all the answers

    The primary treatment for acute myocardial infarction within 12 hours of symptom onset is percutaneous coronary intervention.

    <p>True</p> Signup and view all the answers

    The presence of pathological Q waves is a manifestation of stable angina.

    <p>False</p> Signup and view all the answers

    Raised biochemical markers of myocardial cell death include troponin enzymes.

    <p>True</p> Signup and view all the answers

    Patients presenting with acute myocardial infarction do not need to be hospitalized in a specialized coronary care unit.

    <p>False</p> Signup and view all the answers

    Morphine sulfate is recommended primarily to increase sympathetic discharge and heart work.

    <p>False</p> Signup and view all the answers

    Routine oxygen administration in patients with arterial occlusion has established significance in reducing mortality.

    <p>False</p> Signup and view all the answers

    Thrombolytic therapy should be administered as late as possible for optimal results.

    <p>False</p> Signup and view all the answers

    The standard intravenous dosage of heparin for emergency anticoagulation is 10,000 IU followed by 5,000 IU every 8 hours.

    <p>True</p> Signup and view all the answers

    Nitrates are used in combination with beta-blockers to enhance the size of a myocardial infarction.

    <p>False</p> Signup and view all the answers

    Sedatives like diazepam are administered to reduce anxiety and ensure patient comfort during treatment for arterial occlusion.

    <p>True</p> Signup and view all the answers

    The introduction of a balloon catheter into an occluded artery is performed without imaging guidance.

    <p>False</p> Signup and view all the answers

    Anticoagulant drugs are particularly crucial for patients with a history of previous myocardial infarction.

    <p>True</p> Signup and view all the answers

    What unique action do pFOX inhibitors like trimetazidine perform in the myocardium?

    <p>They partially inhibit fatty acid oxidation, promoting a metabolic switch to carbohydrate utilization.</p> Signup and view all the answers

    How do pFOX inhibitors impact intracellular ionic concentrations?

    <p>They lead to a decrease in intracellular Ca2+ and Na+ accumulation.</p> Signup and view all the answers

    In managing chronic stable angina, which combination therapies are pFOX inhibitors commonly paired with?

    <p>They are used in combination with β-blockers, CCBs, and nitrates.</p> Signup and view all the answers

    What is a key limitation of the efficacy of newer anti-anginal drugs like pFOX inhibitors?

    <p>Their efficacy in treating angina is still considered controversial.</p> Signup and view all the answers

    How do potassium channel openers contribute to the management of chronic angina?

    <p>They enhance myocardial blood flow and decrease myocardial oxygen demand.</p> Signup and view all the answers

    What physiological changes result from the 'metabolic switch' induced by pFOX inhibitors?

    <p>The switch reduces oxygen consumption and improves energy utilization in the heart.</p> Signup and view all the answers

    In terms of cardiac function, what is the primary effect of pFOX inhibitors on heart rate and blood pressure?

    <p>pFOX inhibitors do not affect heart rate or blood pressure.</p> Signup and view all the answers

    What role does decreased intracellular lactic acidosis play in the action of pFOX inhibitors?

    <p>It leads to improved cardiac efficiency and reduced risk of cell necrosis.</p> Signup and view all the answers

    Which medication is least preferred for managing hypertension?

    <p>Nitrates are considered the least preferred for managing hypertension.</p> Signup and view all the answers

    Explain why β-blockers with intrinsic sympathomimetic activity (ISA) should be avoided in patients with angina.

    <p>They provide minimal reduction in heart rate and oxygen consumption, which is insufficient for effective angina management.</p> Signup and view all the answers

    What symptom must patients exhibit for acute myocardial infarction to require hospitalization?

    <p>Patients must exhibit persistent central crushing chest pain.</p> Signup and view all the answers

    For patients with diabetes mellitus, which medication is preferred over beta-blockers?

    <p>Nitrates are preferred over beta-blockers for managing patients with diabetes mellitus.</p> Signup and view all the answers

    What effect do β-blockers have on myocardial work and oxygen demand in exertional angina?

    <p>They decrease contractility, heart rate, and systolic blood pressure, leading to reduced myocardial work and oxygen demand.</p> Signup and view all the answers

    What is the most preferred treatment for heart failure as indicated in the content?

    <p>Amlodipine is the most preferred treatment for heart failure.</p> Signup and view all the answers

    Discuss the reason β-blockers are contraindicated in patients with Prinzmetal's angina.

    <p>They block β2-mediated coronary dilation, which exacerbates coronary spasm by leaving α1 receptors unopposed.</p> Signup and view all the answers

    What is the indicated treatment of choice for acute myocardial infarction within 12 hours of symptom onset?

    <p>Percutaneous coronary intervention (PCI) is the treatment of choice.</p> Signup and view all the answers

    In combination therapy, how do β-blockers and nitrates interact regarding diastolic filling time?

    <p>While β-blockers increase diastolic filling time, nitrates decrease it; however, the combination can maintain or enhance overall filling.</p> Signup and view all the answers

    What is one key biochemical marker indicating myocardial cell death?

    <p>Troponin enzyme levels are key biochemical markers of myocardial cell death.</p> Signup and view all the answers

    Identify a key risk associated with using short-acting dihydropyridine calcium channel blockers.

    <p>They are linked with an increased risk of acute coronary syndrome (ACS).</p> Signup and view all the answers

    Explain the cytoprotective effect of β-blockers in myocardial metabolism.

    <p>They induce a metabolic shift from fat utilization to carbohydrate utilization, improving myocardial energy efficiency.</p> Signup and view all the answers

    Which class of medications are generally avoided in patients with Prinzmetal's angina?

    <p>Beta-blockers are generally avoided in patients with Prinzmetal's angina.</p> Signup and view all the answers

    What are the common effects of combining beta-blockers with nitrates?

    <p>The combination can enhance the efficacy of angina management but may result in increased heart rate.</p> Signup and view all the answers

    How does the combination of long-acting dihydropyridines and β-blockers contribute to angina management?

    <p>It enhances efficacy while reducing potential side effects by optimizing heart rate and contractility control.</p> Signup and view all the answers

    What is the primary role of calcium channel blockers in treating chronic stable angina?

    <p>They are effective in dilating coronary arteries and reducing myocardial oxygen demand.</p> Signup and view all the answers

    What are the two proposed mechanisms of action for nicorandil?

    <p>Nicorandil opens ATP-dependent K+ channels leading to vasodilation and has a nitrate-like component that increases cGMP.</p> Signup and view all the answers

    How does ranolazine affect intracellular calcium levels?

    <p>Ranolazine decreases intracellular Ca2+ levels by reducing the late Na+ current, which indirectly reduces Ca2+ entry into myocardial cells.</p> Signup and view all the answers

    What tolerance issue is associated with the use of traditional nitrates compared to nicorandil?

    <p>Unlike traditional nitrates, tolerance to the effects of nicorandil is less marked.</p> Signup and view all the answers

    Which specific medication interaction should be avoided when using nicorandil?

    <p>Nicorandil should not be used with sildenafil.</p> Signup and view all the answers

    In what way does ranolazine impact heart rate and blood pressure?

    <p>Ranolazine does not affect heart rate or blood pressure.</p> Signup and view all the answers

    What is the primary benefit of using nicorandil in terms of vascular effects?

    <p>Nicorandil provides vasodilation of both peripheral and coronary arteries.</p> Signup and view all the answers

    How does the mechanism of action of ranolazine differ from traditional anti-anginal drugs?

    <p>Ranolazine primarily reduces intracellular sodium and calcium levels instead of focusing on heart rate reduction or vasodilation.</p> Signup and view all the answers

    Why is it important to consider comorbid conditions when choosing an antianginal medication?

    <p>Comorbid conditions can influence the efficacy and safety profile of antianginal drugs, requiring personalized treatment approaches.</p> Signup and view all the answers

    What is the primary effect of morphine sulfate in managing patients with arterial occlusion?

    <p>Morphine sulfate primarily provides analgesia and reduces cardiac workload by causing venodilation.</p> Signup and view all the answers

    What is the significance of using antithrombotic agents like heparin in patients with a history of myocardial infarction?

    <p>Antithrombotic agents like heparin reduce the risk of further clot formation and manage ischemia.</p> Signup and view all the answers

    Why is routine oxygen administration considered to have doubtful significance in the treatment of arterial occlusion?

    <p>Recent evidence suggests that routine oxygen does not significantly reduce mortality in these patients.</p> Signup and view all the answers

    What is the role of thrombolytic therapy in treating arterial occlusion?

    <p>Thrombolytic therapy aims to dissolve clots promptly to restore blood flow and limit myocardial damage.</p> Signup and view all the answers

    How does the administration of nitrates help in the management of myocardial infarction?

    <p>Nitrates help to dilate blood vessels, thus limiting the size of the myocardial infarction.</p> Signup and view all the answers

    What is the sedative effect of diazepam in patients suffering from arterial occlusion?

    <p>Diazepam is used to reduce anxiety and create a calming effect, which can ease patient stress.</p> Signup and view all the answers

    What adverse physiological effect does morphine sulfate induce that impacts cardiac function?

    <p>Morphine sulfate causes venodilation, leading to decreased venous return and heart workload.</p> Signup and view all the answers

    What is the initial dosing recommendation for heparin in acute emergency situations?

    <p>The initial recommended dose of heparin is 10,000 IU intravenously.</p> Signup and view all the answers

    Amlodipine is the CCB of best choice for symptomatic treatment of angina and/or hypertension in patients with chronic ______.

    <p>heart failure</p> Signup and view all the answers

    PFOX inhibitors, potassium channel openers, and ______ are examples of new anti-anginal drugs.

    <p>ranolazine</p> Signup and view all the answers

    They are termed pFOX inhibitors because they partially inhibit fatty acid oxidation in the ______.

    <p>myocardium</p> Signup and view all the answers

    This metabolic switch from fats to carbohydrate utilization requires less ______.

    <p>O2 consumption</p> Signup and view all the answers

    By inhibition of fatty acid oxidation, they decrease intracellular lactic acidosis leading to decreased intracellular ______ and Na+ accumulation.

    <p>Ca2+</p> Signup and view all the answers

    PFOX inhibitors help preserve contractile ______ and prevent cell necrosis.

    <p>function</p> Signup and view all the answers

    The efficacy of pFOX inhibitors in the treatment of angina is ______; however, they are approved for treatment of chronic stable angina.

    <p>controversial</p> Signup and view all the answers

    These newer options are approved for treatment of chronic stable angina in combination with β-blockers, CCBs, and ______.

    <p>nitrates</p> Signup and view all the answers

    β-blockers with ______ should be avoided because the reduction in HR and O2 consumption would be minimal.

    <p>ISA</p> Signup and view all the answers

    β-blockers are contraindicated in Prinzmetal’s angina because they block the β2-mediated coronary ______.

    <p>dilatation</p> Signup and view all the answers

    Calcium channel blockers are considered first-line treatment for ______ angina.

    <p>Prinzmetal's</p> Signup and view all the answers

    The combination of β-blockers and nitrates can decrease ______ and improve efficiency.

    <p>side effects</p> Signup and view all the answers

    Short acting dihydropyridines are associated with increased risk of ______ and should be avoided.

    <p>ACS</p> Signup and view all the answers

    Long acting dihydropyridines, such as ______, are preferred for treating angina.

    <p>amlodipine</p> Signup and view all the answers

    Calcium channel blockers are considered a second-line alternative after β-blockers in chronic stable ______.

    <p>angina</p> Signup and view all the answers

    β-blockers reduce contractility, HR, and systolic BP which ultimately leads to decreased myocardial ______.

    <p>work</p> Signup and view all the answers

    Nico______ is a new anti-anginal drug with proposed mechanisms of action.

    <p>randil</p> Signup and view all the answers

    It opens ATP-dependent K+ channels in the vascular wall leading to VD of peripheral and coronary ______.

    <p>arteries</p> Signup and view all the answers

    Nitrate-like activity includes a component that ↑ ______.

    <p>cGMP</p> Signup and view all the answers

    Ranolazine reduces intracellular Ca2+ indirectly by reducing the late ______ current.

    <p>Na+</p> Signup and view all the answers

    Ranolazine does not affect HR, blood pressure, or coronary ______ flow.

    <p>blood</p> Signup and view all the answers

    The choice of antianginal drugs in patients with comorbid ______ should be considered.

    <p>conditions</p> Signup and view all the answers

    Ranolazine's reduction in intracellular Na2+ load reduces cardiac ______ and work.

    <p>contractility</p> Signup and view all the answers

    Like nitrates, nicorandil should not be used with ______.

    <p>sildenafil</p> Signup and view all the answers

    For patients with bronchial asthma, the least preferred medication is ______.

    <p>Beta-blockers</p> Signup and view all the answers

    The most preferred treatment for heart failure is ______.

    <p>Amlodipine</p> Signup and view all the answers

    In the management of hypertension, ______ is preferred.

    <p>Beta-blockers</p> Signup and view all the answers

    For diabetes mellitus, the least preferred medication is ______.

    <p>Beta-blockers</p> Signup and view all the answers

    In acute myocardial infarction (AMI), ______ must be hospitalized in a specialized coronary care unit.

    <p>all cases</p> Signup and view all the answers

    The treatment of choice for patients presenting within 12 hours of symptom onset is ______.

    <p>percutaneous coronary intervention</p> Signup and view all the answers

    Manifestations of AMI include persistent central chest pain and ______ ST segment changes.

    <p>elevation or depression</p> Signup and view all the answers

    All patients presenting with biochemical markers of myocardial cell death must be ______.

    <p>hospitalized</p> Signup and view all the answers

    A ______ is guided by x-ray imaging into the occluded artery to open it.

    <p>balloon</p> Signup and view all the answers

    Morphine sulfate is administered to produce ______ and decrease stress of the patient.

    <p>analgesia</p> Signup and view all the answers

    Routine oxygen administration is suggested to have ______ significance.

    <p>doubtful</p> Signup and view all the answers

    Anticoagulant drugs, such as ______, are used especially when there is a history of previous myocardial infarction.

    <p>heparin</p> Signup and view all the answers

    Thrombolytic therapy is most effective when administered as early as ______.

    <p>possible</p> Signup and view all the answers

    Sedatives like diazepam help manage ______ during treatment.

    <p>anxiety</p> Signup and view all the answers

    Morphine causes venodilation, which leads to decreased ______ and cardiac workload.

    <p>venous return</p> Signup and view all the answers

    The standard dosage of heparin given intravenously is ______ IU.

    <p>10,000</p> Signup and view all the answers

    Match the following anti-anginal drugs with their mechanisms of action:

    <p>Amlodipine = Calcium channel blocker Trimetazidine = pFOX inhibitor Ranolazine = Late sodium current inhibitor Potassium channel openers = K+ channel manipulation to increase blood flow</p> Signup and view all the answers

    Match the following anti-anginal drugs with their primary clinical application:

    <p>Amlodipine = Treatment of angina and hypertension in chronic heart failure Trimetazidine = Management of chronic stable angina Ranolazine = Second-line therapy in angina Potassium channel openers = Adjunctive therapy in chronic angina</p> Signup and view all the answers

    Match the following effects with their corresponding anti-anginal drugs:

    <p>Amlodipine = Reduces myocardial oxygen demand Trimetazidine = Decreases lactic acidosis Ranolazine = Prevents intracellular sodium overload Potassium channel openers = Enhances coronary blood flow</p> Signup and view all the answers

    Match the following drug classes with their characteristics:

    <p>Calcium channel blockers = Vasodilators that lower blood pressure pFOX inhibitors = Metabolic modifiers affecting fatty acid oxidation Potassium channel openers = Compounds that induce vasodilation through K+ channels β-blockers = Reduce heart rate and myocardial contractility</p> Signup and view all the answers

    Match the following anti-anginal drugs with their expected side effects:

    <p>Amlodipine = Peripheral edema Trimetazidine = Dizziness Ranolazine = Nausea Potassium channel openers = Hypotension</p> Signup and view all the answers

    Match the following drug mechanisms with their consequences:

    <p>Amlodipine = Increased oxygen delivery during myocardial ischemia Trimetazidine = Reduced oxidative stress in myocardium Ranolazine = Improved diastolic function Potassium channel openers = Decreased vascular resistance</p> Signup and view all the answers

    Match the following therapies with their respective drug combinations:

    <p>β-blockers = Often combined with CCBs pFOX inhibitors = Used with β-blockers for chronic stable angina Potassium channel openers = Combined with nitrates for synergistic effect Calcium channel blockers = Typically paired with ACE inhibitors</p> Signup and view all the answers

    Match the following outcomes with the actions of new anti-anginal drugs:

    <p>Metabolic modifiers = Alter energy substrate utilization Calcium channel blockers = Relieve angina symptoms effectively Ranolazine = Attenuate ischemic damage at cellular level β-blockers = Minimize heart rate during exertion</p> Signup and view all the answers

    Match the following β-blocker effects with their corresponding outcomes:

    <p>Decrease heart rate = Reduced myocardial oxygen demand Increase diastolic filling time = Improved coronary perfusion Decrease blood pressure = Lowered cardiac workload Redistribution of blood = Increased perfusion to ischemic areas</p> Signup and view all the answers

    Match the following characteristics with their respective medications:

    <p>Short-acting dihydropyridines = Increased risk of acute coronary syndrome Long-acting dihydropyridines = Preferred for chronic stable angina Non-dihydropyridines = Used for Prinzmetal's angina β-blockers = Contraindicated in Prinzmetal's angina</p> Signup and view all the answers

    Match the following mechanisms of action with their associated drug class:

    <p>β-blockers = Reduce contractility and heart rate Calcium channel blockers = Prevent coronary vasospasm Nitrates = Increase myocardial oxygen supply Combination therapy (β-blockers + nitrates) = Enhance therapeutic efficacy</p> Signup and view all the answers

    Match the following drugs with their primary mechanism of action:

    <p>Nicorandil = Opens ATP-dependent K+ channels Ranolazine = Reduces intracellular Na+ load Nitrates = Increases cGMP levels Antiplatelets = Inhibit platelet aggregation</p> Signup and view all the answers

    Match the following outcomes with their respective treatments for angina:

    <p>Prinzmetal's angina = Calcium channel blockers as first-line treatment Chronic stable angina = β-blockers preferred as first line Inappropriate use of β-blockers = Associated with coronary vasospasm Effective angina management = Therapeutic combination of β-blockers and nitrates</p> Signup and view all the answers

    Match the following pharmacological effects with the correct agents:

    <p>HR decrease with β-blockers = Heart rate stability during exertion Diastolic filling time increase with β-blockers = Improved coronary circulation Contractility increase with nitrates = Reflex tachycardia effect Blood pressure lowering with combination therapy = Reduction in overall cardiac workload</p> Signup and view all the answers

    Match the following mechanisms with the corresponding effects:

    <p>Decreased intracellular Ca2+ = Reduced cardiac contractility Nitrate-like activity = Vasodilation in coronary arteries ATP-dependent K+ channel opening = Vasodilation of peripheral arteries Na+ current modulation = Indirect reduction in Ca2+ entry</p> Signup and view all the answers

    Match the following effects of drugs with their description:

    <p>Nicorandil's nitrate effect = Similar to nitrates but less tolerance Ranolazine's action = Does not affect heart rate Nitrates' side effect = Tolerance develops with continuous use Antiplatelet drugs = Used to lower risk in myocardial infarction</p> Signup and view all the answers

    Match the following β-blocker properties with their clinical implications:

    <p>Cytoprotective effect = Switch from fat to carbohydrate metabolism ISA in β-blockers = Limited heart rate reduction Blockade of β2 receptors = Exacerbation of coronary vasospasm Heart rate response upon combination therapy = Variable effect depending on the combination</p> Signup and view all the answers

    Match the following classes of medications with their specific angina management scenarios:

    <p>Calcium Channel Blockers = First-line for Prinzmetal's angina β-blockers = Second-line for chronic stable angina contraindications Long-acting nitrates = Used for stable angina management Short-acting dihydropyridines = Avoided in acute coronary syndrome risk</p> Signup and view all the answers

    Match the following conditions with their potential treatment options:

    <p>Chronic angina = Ranolazine Angina with comorbidities = Combination therapy Acute myocardial infarction = Anticoagulants Coronary artery disease = Antiplatelet therapy</p> Signup and view all the answers

    Match the following drug classes with their specific interactions or characteristics:

    <p>Nitrates = Should not be used with sildenafil Calcium channel blockers = Primarily reduce contractility β-blockers = First-line for Prinzmetal's angina PFOX inhibitors = Increased intracellular lactic acidosis</p> Signup and view all the answers

    Match the following statements regarding angina management with their corresponding truths:

    <p>β-blockers minimize HR and contractility = Decreased myocardial oxygen consumption CCBs improve coronary blood flow = Effective in variant angina management Nitrates cause reflex tachycardia = Characterize combination effects with β-blockers Dihydropyridines impact dosage forms = Significant variation in efficacy and safety</p> Signup and view all the answers

    Match the following adverse effects with the respective drug:

    <p>Ranolazine = No effect on coronary blood flow Nitrates = Development of tolerance Nicorandil = Combination effect with nitrates Antiplatelets = Risk of bleeding complications</p> Signup and view all the answers

    Match the following components of angina treatment with their purposes:

    <p>Calcium channel blockers = Decrease myocardial oxygen demand Anticoagulants = Limit myocardial infarction size β-blockers = Increase diastolic filling time Sildenafil = Contraindicated with nitrates</p> Signup and view all the answers

    Match the following patient conditions with their relevant drug considerations:

    <p>Heart failure = Amlodipine preferred CCB Myocardial infarction history = Use of anticoagulants Angina with diabetes = Consider β-blockers carefully Acute coronary syndrome = Avoid dihydropyridine CCBs</p> Signup and view all the answers

    Match the following medical conditions with their most and least preferred treatments:

    <p>Bronchial asthma = Nitrates Heart failure = Amlodipine Hypertension = Beta-blockers, CCBs Diabetes mellitus = Nitrates, Nifedipine</p> Signup and view all the answers

    Match the following medications with their classifications regarding preferred use:

    <p>Nitrates = Least preferred for bronchial asthma Amlodipine = Most preferred for heart failure Beta-blockers = Most preferred for hypertension Nifedipine = Least preferred for diabetes mellitus</p> Signup and view all the answers

    Match the following interventions with their context of use in acute myocardial infarction (AMI):

    <p>Percutaneous coronary intervention (PCI) = Treatment of choice within 12 hours of symptom onset Biochemical markers (troponin) = Indication of myocardial cell death ST segment elevation = Manifestation of persistent chest pain Coronary care unit = Required for all cases of AMI</p> Signup and view all the answers

    Match the following drugs with their primary benefits in managing specific conditions:

    <p>Beta-blockers = Cytoprotective effect in heart failure CCBs = Reducing contractility in chronic stable angina Nitrates = Least preferred for hypertension Amlodipine = Preferred CCB for treating angina and hypertension</p> Signup and view all the answers

    Match the following manifestations with their relevant characteristics in myocardial infarction:

    <p>Central crushing chest pain = Persistent and indicative of AMI Pathological Q wave = Indicator of myocardial cell necrosis ST segment depression = Commonly associated with myocardial ischemia Raised biochemical markers = Indicates myocardial cell death</p> Signup and view all the answers

    Match the following classes of medications with their typical use cases:

    <p>Beta-blockers = Chronic management of heart failure Nitrates = Immediate relief in angina attacks CCBs = Used to manage hypertension Amlodipine = Preferred in chronic stable angina</p> Signup and view all the answers

    Match the following drug interactions with their possible implications:

    <p>CCBs and β-blockers = Caution in patients with acute coronary syndrome Nitrates and Amlodipine = Possible synergistic effect on blood pressure Nifedipine and Beta-blockers = Increased risk of adverse effects Verapamil and other CCBs = Potential for additive side effects</p> Signup and view all the answers

    Match the following concepts regarding treatment in myocardial infarction with corresponding procedures:

    <p>Morphine sulfate = Decreases cardiac workload Sedatives like diazepam = Calm patients during treatment Anticoagulation drugs = Limit size of myocardial infarction Thrombolytic therapy = Reestablish blood flow in occlusion cases</p> Signup and view all the answers

    Match the following pharmacological agents with their primary purpose in the treatment of arterial occlusion:

    <p>Morphine sulfate = Decrease cardiac workload and provide analgesia Oxygen = Routine administration to improve oxygenation Anticoagulant drugs = Prevent clot extension and re-occlusion Thrombolytic therapy = Dissolve existing clots to restore blood flow</p> Signup and view all the answers

    Match the following dosages with the corresponding medications used in acute myocardial infarction treatment:

    <p>Morphine sulfate = 5 mg i.v. Heparin = 10,000 IU i.v. Diazepam = 5 mg i.v. Nitrates = Administer as needed for chest pain</p> Signup and view all the answers

    Match the following descriptions to their corresponding outcomes related to oxygen administration in myocardial infarction:

    <p>Routine oxygen therapy = Doubtful significance in mortality reduction High-flow oxygen = Potential for increased coronary demand Oxygen saturation monitoring = Ensures adequate tissue oxygenation Oxygen therapy in hypoxia = Essential to prevent ischemic damage</p> Signup and view all the answers

    Match the following medications with their specific mechanism of action in myocardial infarction management:

    <p>Morphine sulfate = Venodilation and reduction of sympathetic discharge Nitrates = Causes venodilation and decreases preload Anticoagulants = Inhibit clot formation Thrombolytics = Lyse fibrin to dissolve clots</p> Signup and view all the answers

    Match the following agents with their primary use in myocardial infarction treatment:

    <p>Morphine = Analgesia and ↓ sympathetic output Oxygen = Maintain tissue oxygenation when needed Heparin = Prevent thrombus formation in obeses patients Thrombolytics = Early intervention to restore blood flow</p> Signup and view all the answers

    Match the following pharmacological effects with their respective drugs in the context of myocardial infarction:

    <p>Morphine sulfate = Relieves pain and anxiety Nitrates = Reduces myocardial oxygen demand Oxygen administration = Improves tissue oxygenation Thrombolytics = Restores blood flow by dissolving clots</p> Signup and view all the answers

    Match the following agents with their role in limiting myocardial infarction damage:

    <p>Beta-blockers = Limit infarct size Nitrates = Decrease myocardial oxygen consumption Morphine sulfate = Relieve pain and decrease workload Anticoagulants = Prevent additional clotting events</p> Signup and view all the answers

    Match the following treatments to their primary goals in patients with acute myocardial infarction:

    <p>Morphine = Analgesia and ↓ cardiac workload Oxygen = Ensure adequate oxygenation Thrombolytics = Achieve rapid reperfusion Anticoagulants = Suppress further thrombus development</p> Signup and view all the answers

    Study Notes

    β-Blockers

    • No specific evidence shows superiority among different β-blockers.
    • Avoid β-blockers with intrinsic sympathomimetic activity (ISA) as they minimally reduce heart rate and oxygen consumption.
    • Contraindicated in Prinzmetal's angina due to blocking β2-mediated coronary dilation, which can trigger increased coronary spasm.
    • Mechanism: Decrease contractility, heart rate, and systolic blood pressure, which reduces myocardial work and oxygen demand.
    • Increase diastolic coronary filling time and redistribute blood from healthy to ischemic areas.
    • Provide cytoprotective effects by switching myocardial metabolism from fat to carbohydrates, improving efficiency.

    Combination Therapy

    • Combining β-blockers and nitrates enhances efficacy and minimizes side effects:
      • Heart Rate: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Contractility: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Diastolic Filling Time: β-blockers increase; nitrates decrease; combination shows no effect or an increase.
      • Blood Pressure: Both β-blockers and nitrates decrease, but combination leads to greater reduction.

    Calcium Channel Blockers (CCBs)

    • First-line treatment for Prinzmetal’s angina.
    • Second-line alternative for chronic stable angina when β-blockers are contraindicated.
    • Short-acting dihydropyridines pose risk of acute coronary syndrome and should be avoided.
    • Long-acting dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil, diltiazem) are preferred.
    • Amlodipine is especially effective for symptomatic treatment in chronic heart failure patients.

    New Treatment Options for Chronic Angina

    • pFOX inhibitors (e.g., trimetazidine) partially inhibit fatty acid oxidation to improve myocardial metabolism and reduce oxygen consumption without affecting heart rate or blood flow.
    • Potassium channel openers (e.g., nicorandil) induce vasodilation and have a mechanism similar to nitrates with reduced tolerance.
    • Ranolazine reduces intracellular sodium, indirectly decreasing calcium entry and myocardial workload, with no significant effect on heart rate or blood pressure.

    Antiplatelets and Lowering Drugs

    • Consider pharmacological profiles of antiplatelet agents when managing comorbid diseases in angina patients.

    Preferred Treatments by Comorbid Disease

    • Bronchial Asthma: Nitrates and CCBs preferred over β-blockers.
    • Heart Failure: Amlodipine preferred; β-blockers and verapamil less preferred.
    • Hypertension: β-blockers and CCBs preferred; nitrates less preferred.
    • Diabetes Mellitus: Nitrates and nifedipine preferred; β-blockers and verapamil less preferred.

    Management of Acute Myocardial Infarction (AMI)

    • Symptoms include persistent central chest pain, ST segment changes, and elevated biochemical markers (e.g., troponin).
    • All patients should be hospitalized in a specialized coronary care unit.
    • Initial treatment within 12 hours typically involves percutaneous coronary intervention (PCI) to open occluded arteries.

    Pharmacologic Therapy for AMI

    • Morphine sulfate is used to relieve pain and reduce cardiac workload and stress.
    • Oxygen administration is less significant than previously thought for mortality reduction.
    • Nitroglycerin is used to limit infarct size.
    • Anticoagulants, such as heparin, are essential, particularly for obese patients or those with previous myocardial infarction.
    • Thrombolytic therapy (e.g., streptokinase, t-PA) is most effective when administered early.
    • Sedatives, like diazepam, may assist in patient comfort.

    β-Blockers

    • No specific evidence shows superiority among different β-blockers.
    • Avoid β-blockers with intrinsic sympathomimetic activity (ISA) as they minimally reduce heart rate and oxygen consumption.
    • Contraindicated in Prinzmetal's angina due to blocking β2-mediated coronary dilation, which can trigger increased coronary spasm.
    • Mechanism: Decrease contractility, heart rate, and systolic blood pressure, which reduces myocardial work and oxygen demand.
    • Increase diastolic coronary filling time and redistribute blood from healthy to ischemic areas.
    • Provide cytoprotective effects by switching myocardial metabolism from fat to carbohydrates, improving efficiency.

    Combination Therapy

    • Combining β-blockers and nitrates enhances efficacy and minimizes side effects:
      • Heart Rate: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Contractility: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Diastolic Filling Time: β-blockers increase; nitrates decrease; combination shows no effect or an increase.
      • Blood Pressure: Both β-blockers and nitrates decrease, but combination leads to greater reduction.

    Calcium Channel Blockers (CCBs)

    • First-line treatment for Prinzmetal’s angina.
    • Second-line alternative for chronic stable angina when β-blockers are contraindicated.
    • Short-acting dihydropyridines pose risk of acute coronary syndrome and should be avoided.
    • Long-acting dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil, diltiazem) are preferred.
    • Amlodipine is especially effective for symptomatic treatment in chronic heart failure patients.

    New Treatment Options for Chronic Angina

    • pFOX inhibitors (e.g., trimetazidine) partially inhibit fatty acid oxidation to improve myocardial metabolism and reduce oxygen consumption without affecting heart rate or blood flow.
    • Potassium channel openers (e.g., nicorandil) induce vasodilation and have a mechanism similar to nitrates with reduced tolerance.
    • Ranolazine reduces intracellular sodium, indirectly decreasing calcium entry and myocardial workload, with no significant effect on heart rate or blood pressure.

    Antiplatelets and Lowering Drugs

    • Consider pharmacological profiles of antiplatelet agents when managing comorbid diseases in angina patients.

    Preferred Treatments by Comorbid Disease

    • Bronchial Asthma: Nitrates and CCBs preferred over β-blockers.
    • Heart Failure: Amlodipine preferred; β-blockers and verapamil less preferred.
    • Hypertension: β-blockers and CCBs preferred; nitrates less preferred.
    • Diabetes Mellitus: Nitrates and nifedipine preferred; β-blockers and verapamil less preferred.

    Management of Acute Myocardial Infarction (AMI)

    • Symptoms include persistent central chest pain, ST segment changes, and elevated biochemical markers (e.g., troponin).
    • All patients should be hospitalized in a specialized coronary care unit.
    • Initial treatment within 12 hours typically involves percutaneous coronary intervention (PCI) to open occluded arteries.

    Pharmacologic Therapy for AMI

    • Morphine sulfate is used to relieve pain and reduce cardiac workload and stress.
    • Oxygen administration is less significant than previously thought for mortality reduction.
    • Nitroglycerin is used to limit infarct size.
    • Anticoagulants, such as heparin, are essential, particularly for obese patients or those with previous myocardial infarction.
    • Thrombolytic therapy (e.g., streptokinase, t-PA) is most effective when administered early.
    • Sedatives, like diazepam, may assist in patient comfort.

    β-Blockers

    • No specific evidence shows superiority among different β-blockers.
    • Avoid β-blockers with intrinsic sympathomimetic activity (ISA) as they minimally reduce heart rate and oxygen consumption.
    • Contraindicated in Prinzmetal's angina due to blocking β2-mediated coronary dilation, which can trigger increased coronary spasm.
    • Mechanism: Decrease contractility, heart rate, and systolic blood pressure, which reduces myocardial work and oxygen demand.
    • Increase diastolic coronary filling time and redistribute blood from healthy to ischemic areas.
    • Provide cytoprotective effects by switching myocardial metabolism from fat to carbohydrates, improving efficiency.

    Combination Therapy

    • Combining β-blockers and nitrates enhances efficacy and minimizes side effects:
      • Heart Rate: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Contractility: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Diastolic Filling Time: β-blockers increase; nitrates decrease; combination shows no effect or an increase.
      • Blood Pressure: Both β-blockers and nitrates decrease, but combination leads to greater reduction.

    Calcium Channel Blockers (CCBs)

    • First-line treatment for Prinzmetal’s angina.
    • Second-line alternative for chronic stable angina when β-blockers are contraindicated.
    • Short-acting dihydropyridines pose risk of acute coronary syndrome and should be avoided.
    • Long-acting dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil, diltiazem) are preferred.
    • Amlodipine is especially effective for symptomatic treatment in chronic heart failure patients.

    New Treatment Options for Chronic Angina

    • pFOX inhibitors (e.g., trimetazidine) partially inhibit fatty acid oxidation to improve myocardial metabolism and reduce oxygen consumption without affecting heart rate or blood flow.
    • Potassium channel openers (e.g., nicorandil) induce vasodilation and have a mechanism similar to nitrates with reduced tolerance.
    • Ranolazine reduces intracellular sodium, indirectly decreasing calcium entry and myocardial workload, with no significant effect on heart rate or blood pressure.

    Antiplatelets and Lowering Drugs

    • Consider pharmacological profiles of antiplatelet agents when managing comorbid diseases in angina patients.

    Preferred Treatments by Comorbid Disease

    • Bronchial Asthma: Nitrates and CCBs preferred over β-blockers.
    • Heart Failure: Amlodipine preferred; β-blockers and verapamil less preferred.
    • Hypertension: β-blockers and CCBs preferred; nitrates less preferred.
    • Diabetes Mellitus: Nitrates and nifedipine preferred; β-blockers and verapamil less preferred.

    Management of Acute Myocardial Infarction (AMI)

    • Symptoms include persistent central chest pain, ST segment changes, and elevated biochemical markers (e.g., troponin).
    • All patients should be hospitalized in a specialized coronary care unit.
    • Initial treatment within 12 hours typically involves percutaneous coronary intervention (PCI) to open occluded arteries.

    Pharmacologic Therapy for AMI

    • Morphine sulfate is used to relieve pain and reduce cardiac workload and stress.
    • Oxygen administration is less significant than previously thought for mortality reduction.
    • Nitroglycerin is used to limit infarct size.
    • Anticoagulants, such as heparin, are essential, particularly for obese patients or those with previous myocardial infarction.
    • Thrombolytic therapy (e.g., streptokinase, t-PA) is most effective when administered early.
    • Sedatives, like diazepam, may assist in patient comfort.

    β-Blockers

    • No specific evidence shows superiority among different β-blockers.
    • Avoid β-blockers with intrinsic sympathomimetic activity (ISA) as they minimally reduce heart rate and oxygen consumption.
    • Contraindicated in Prinzmetal's angina due to blocking β2-mediated coronary dilation, which can trigger increased coronary spasm.
    • Mechanism: Decrease contractility, heart rate, and systolic blood pressure, which reduces myocardial work and oxygen demand.
    • Increase diastolic coronary filling time and redistribute blood from healthy to ischemic areas.
    • Provide cytoprotective effects by switching myocardial metabolism from fat to carbohydrates, improving efficiency.

    Combination Therapy

    • Combining β-blockers and nitrates enhances efficacy and minimizes side effects:
      • Heart Rate: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Contractility: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Diastolic Filling Time: β-blockers increase; nitrates decrease; combination shows no effect or an increase.
      • Blood Pressure: Both β-blockers and nitrates decrease, but combination leads to greater reduction.

    Calcium Channel Blockers (CCBs)

    • First-line treatment for Prinzmetal’s angina.
    • Second-line alternative for chronic stable angina when β-blockers are contraindicated.
    • Short-acting dihydropyridines pose risk of acute coronary syndrome and should be avoided.
    • Long-acting dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil, diltiazem) are preferred.
    • Amlodipine is especially effective for symptomatic treatment in chronic heart failure patients.

    New Treatment Options for Chronic Angina

    • pFOX inhibitors (e.g., trimetazidine) partially inhibit fatty acid oxidation to improve myocardial metabolism and reduce oxygen consumption without affecting heart rate or blood flow.
    • Potassium channel openers (e.g., nicorandil) induce vasodilation and have a mechanism similar to nitrates with reduced tolerance.
    • Ranolazine reduces intracellular sodium, indirectly decreasing calcium entry and myocardial workload, with no significant effect on heart rate or blood pressure.

    Antiplatelets and Lowering Drugs

    • Consider pharmacological profiles of antiplatelet agents when managing comorbid diseases in angina patients.

    Preferred Treatments by Comorbid Disease

    • Bronchial Asthma: Nitrates and CCBs preferred over β-blockers.
    • Heart Failure: Amlodipine preferred; β-blockers and verapamil less preferred.
    • Hypertension: β-blockers and CCBs preferred; nitrates less preferred.
    • Diabetes Mellitus: Nitrates and nifedipine preferred; β-blockers and verapamil less preferred.

    Management of Acute Myocardial Infarction (AMI)

    • Symptoms include persistent central chest pain, ST segment changes, and elevated biochemical markers (e.g., troponin).
    • All patients should be hospitalized in a specialized coronary care unit.
    • Initial treatment within 12 hours typically involves percutaneous coronary intervention (PCI) to open occluded arteries.

    Pharmacologic Therapy for AMI

    • Morphine sulfate is used to relieve pain and reduce cardiac workload and stress.
    • Oxygen administration is less significant than previously thought for mortality reduction.
    • Nitroglycerin is used to limit infarct size.
    • Anticoagulants, such as heparin, are essential, particularly for obese patients or those with previous myocardial infarction.
    • Thrombolytic therapy (e.g., streptokinase, t-PA) is most effective when administered early.
    • Sedatives, like diazepam, may assist in patient comfort.

    β-Blockers

    • No specific evidence shows superiority among different β-blockers.
    • Avoid β-blockers with intrinsic sympathomimetic activity (ISA) as they minimally reduce heart rate and oxygen consumption.
    • Contraindicated in Prinzmetal's angina due to blocking β2-mediated coronary dilation, which can trigger increased coronary spasm.
    • Mechanism: Decrease contractility, heart rate, and systolic blood pressure, which reduces myocardial work and oxygen demand.
    • Increase diastolic coronary filling time and redistribute blood from healthy to ischemic areas.
    • Provide cytoprotective effects by switching myocardial metabolism from fat to carbohydrates, improving efficiency.

    Combination Therapy

    • Combining β-blockers and nitrates enhances efficacy and minimizes side effects:
      • Heart Rate: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Contractility: β-blockers decrease; nitrates increase (reflex); combination shows no effect or a decrease.
      • Diastolic Filling Time: β-blockers increase; nitrates decrease; combination shows no effect or an increase.
      • Blood Pressure: Both β-blockers and nitrates decrease, but combination leads to greater reduction.

    Calcium Channel Blockers (CCBs)

    • First-line treatment for Prinzmetal’s angina.
    • Second-line alternative for chronic stable angina when β-blockers are contraindicated.
    • Short-acting dihydropyridines pose risk of acute coronary syndrome and should be avoided.
    • Long-acting dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., verapamil, diltiazem) are preferred.
    • Amlodipine is especially effective for symptomatic treatment in chronic heart failure patients.

    New Treatment Options for Chronic Angina

    • pFOX inhibitors (e.g., trimetazidine) partially inhibit fatty acid oxidation to improve myocardial metabolism and reduce oxygen consumption without affecting heart rate or blood flow.
    • Potassium channel openers (e.g., nicorandil) induce vasodilation and have a mechanism similar to nitrates with reduced tolerance.
    • Ranolazine reduces intracellular sodium, indirectly decreasing calcium entry and myocardial workload, with no significant effect on heart rate or blood pressure.

    Antiplatelets and Lowering Drugs

    • Consider pharmacological profiles of antiplatelet agents when managing comorbid diseases in angina patients.

    Preferred Treatments by Comorbid Disease

    • Bronchial Asthma: Nitrates and CCBs preferred over β-blockers.
    • Heart Failure: Amlodipine preferred; β-blockers and verapamil less preferred.
    • Hypertension: β-blockers and CCBs preferred; nitrates less preferred.
    • Diabetes Mellitus: Nitrates and nifedipine preferred; β-blockers and verapamil less preferred.

    Management of Acute Myocardial Infarction (AMI)

    • Symptoms include persistent central chest pain, ST segment changes, and elevated biochemical markers (e.g., troponin).
    • All patients should be hospitalized in a specialized coronary care unit.
    • Initial treatment within 12 hours typically involves percutaneous coronary intervention (PCI) to open occluded arteries.

    Pharmacologic Therapy for AMI

    • Morphine sulfate is used to relieve pain and reduce cardiac workload and stress.
    • Oxygen administration is less significant than previously thought for mortality reduction.
    • Nitroglycerin is used to limit infarct size.
    • Anticoagulants, such as heparin, are essential, particularly for obese patients or those with previous myocardial infarction.
    • Thrombolytic therapy (e.g., streptokinase, t-PA) is most effective when administered early.
    • Sedatives, like diazepam, may assist in patient comfort.

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    This quiz explores the role and mechanisms of β-blockers in managing exertional angina. It addresses their effects on heart rate, contractility, and the implications of intrinsic sympathomimetic activity (ISA). Additionally, the contraindications of β-blockers in certain conditions such as Prinzmetal's angina are discussed.

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