Pharmacology: Antianginal Drugs and Angina Pectoris
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Questions and Answers

What is the main pharmacological action of nitroglycerin?

  • Inhibiting coagulation of platelets
  • Reducing oxygen demand
  • Increasing oxygen supply
  • Dilating vessels and reducing heart loads (correct)

    • What is a clinical use of nitroglycerin?

  • Hypertension
  • Arrhythmias
  • Angina pectoris (correct)
  • Heart failure due to increased heart loads

    • What is a possible adverse reaction of nitroglycerin?

  • Decreased contractility
  • Bradycardia
  • Postural hypotension (correct)
  • Increased oxygen demand

    • What is the mechanism of the effect of isosorbide dinitrate compared to nitroglycerin?

    <p>Slower but longer-lasting</p> Signup and view all the answers

    What is the main pharmacological action of β-blockers?

    <p>Reducing oxygen demand</p> Signup and view all the answers

    What is a clinical use of β-blockers?

    <p>Stable angina pectoris associated with hypertension or arrhythmias</p> Signup and view all the answers

    What is an additional effect of β-blockers?

    <p>Improving myocardial metabolism</p> Signup and view all the answers

    What can be used to avoid tolerance to nitrates?

    <p>Supplementing with agents containing –SH</p> Signup and view all the answers

    What is the main cause of cardiac ischemia?

    <p>Coronary atherosclerosis</p> Signup and view all the answers

    What type of angina is characterized by an imbalance between oxygen demand and supply?

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

    What is the primary factor determining myocardial oxygen demand?

    <p>All of the above</p> Signup and view all the answers

    How do antianginal drugs reduce myocardial oxygen demand?

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

    What is the primary way that antianginal drugs increase oxygen supply?

    <p>Dilating conduct coronary arteries</p> Signup and view all the answers

    What is another effect of antianginal drugs?

    <p>Anti-platelet coagulation and thrombus formation</p> Signup and view all the answers

    What is the term for the imbalance between oxygen demand and supply?

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

    What is the classification of angina that occurs when the patient is at rest?

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

    What is the recommended approach for dose individualization of antianginal drugs?

    <p>Starting from a small dose</p> Signup and view all the answers

    What is the effect of nitroglycerin on heart rate?

    <p>Markedly increase</p> Signup and view all the answers

    What is the effect of verapamil and diltiazem on heart rate and contractility?

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

    Which of the following is a clinical use of nifedipine?

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

    What is the effect of β blockers on contractility?

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

    What is the mechanism of action of nicorandil?

    <p>Opening ATP-sensitive K+ channels</p> Signup and view all the answers

    What is the effect of Ca2+ antagonists on wall tension?

    <p>Increase or decrease</p> Signup and view all the answers

    What is the effect of ACEIs on heart loads?

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

    What is the effect of combination therapy on oxygen demand?

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

    What is the classification of cardiovascular diseases based on?

    <p>Target organs/tissues</p> Signup and view all the answers

    Which of the following drugs is similar to beta blockers in its action?

    <p>Verapamil and diltiazem</p> Signup and view all the answers

    What is the basis of most cardiovascular diseases?

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

    What is the effect of dipyridamole on platelet aggregation?

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

    What is the recommended approach for withdrawing antianginal drugs?

    <p>Gradually and slowly withdrawing the drug</p> Signup and view all the answers

    What is the effect of calcium channel blockers on blood pressure?

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

    What is the effect of combination therapy with β blockers and nitroglycerin?

    <p>Potentiates the antianginal effects</p> Signup and view all the answers

    Study Notes

    Overview of Cardiovascular Diseases

    • Common cardiac diseases:
      • Abnormal contractility: Heart failures
      • Abnormal rhythms: Arrhythmias
      • Abnormal blood supply: Ischemic heart diseases
      • Myocardial disorders
    • Common vascular diseases:
      • Abnormal systematic resistance: Hypertension
      • Dysfunction of coronary vessels: Coronary vascular diseases
      • Dysfunction of cerebral vessels: Cerebral ischemia, hemorrhage
      • Dysfunction of pulmonary vessels: Pulmonary hypertension
      • Dysfunction of peripheral vessels: Peripheral vascular disorder
    • Arteriosclerosis: basis of most CVS diseases

    Antianginal Drugs

    Overview

    • Coronary vessels: blood supply for the heart
    • Coronary atherosclerosis: cause of cardiac ischemia
    • Distribution of coronary arteries in the heart
    • Ischemia (angina pectoris): imbalance between oxygen demand and supply
    • Classification of angina pectoris:
      • Exertional angina
      • Stable angina
      • Initial onset angina
      • Accelerated angina
      • Spontaneous angina
      • Angina decubitus
      • Variant or vasospastic angina
      • Acute coronary insufficiency
      • Postinfarction angina
      • Mixed angina
      • Unstable angina

    Myocardial Oxygen Demand and Supply

    • Myocardial oxygen demand is chiefly determined by:
      • Contractility
      • Heart rate
      • Wall tension
      • Preload (venous return)
      • Afterload (arteriolar resistance)
    • Myocardial oxygen demand is diminished by:
      • Reducing contractility
      • Reducing heart rate
      • Reducing the preload
      • Reducing the afterload
    • Myocardial oxygen supply is chiefly determined by:
      • AV oxygen difference
      • Regional myocardial distribution
      • Coronary blood flow
      • Vascular resistance
      • Artery pressure

    Antianginal Drugs

    Nitrates

    • Pharmacological actions:
      • Dilating vessels and reducing heart loads
      • Redistribution of coronary circulation
    • Clinical uses:
      • Angina pectoris: all kinds, especially stable type
      • Heart failure: reducing heart loads due to vasodilation
    • Adverse reactions:
      • Increase in heart rate and contractility
      • Symptoms due to vasodilation
      • Tolerance

    β Receptor Blockers

    • Pharmacological actions:
      • Reducing oxygen demand: heart rate and contractility
      • Increasing oxygen supply: diastolic period and perfusion time
      • Improving myocardial metabolism
      • Inhibiting coagulation of platelets
    • Clinical uses:
      • Stable and unstable angina pectoris, especially associated with hypertension or arrhythmias
    • Notes:
      • Dose individualization: starting from small dose
      • Withdraw gradually and slowly: symptom rebound
      • Combination with nitroglycerin

    Calcium Channel Blockers

    • Pharmacological actions:
      • Reducing myocardial oxygen demand: heart loads
      • Increasing myocardial blood supply
      • Protecting ischemic myocardial cells
      • Inhibiting coagulation of platelets
    • Clinical uses:
      • Stable and variant type: nifedipine, verapamil, diltiazem
      • Unstable type: verapamil, diltiazem
    • Notes:
      • Actions of DHP (like nifedipine) are similar to those of nitroglycerin
      • Actions of verapamil and diltiazem are similar to those of β blockers

    Other Drugs

    • ACEIs:
      • Treating hypertension and preventing ischemic heart disease
      • Reducing heart loads
      • Inhibiting cardiac remodeling
    • Nicorandil:
      • Opening ATP-sensitive K+ channel (KATP)
      • Lowering intracellular Ca2+
      • Providing NO (like nitroglycerin)
      • Inducing ischemic preconditioning
    • Molsidomine:
      • Inhibiting adenosine uptake and cAMP degradation
      • Inhibiting platelet aggregation
      • Promoting collateral circulation after long-term use
    • Dipyridamole:
      • Inhibiting adenosine uptake and cAMP degradation
      • Inhibiting platelet aggregation
      • Promoting collateral circulation after long-term use

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    Description

    This quiz covers the basics of antianginal drugs, including organic nitrates, beta blockers, and calcium channel blockers, as well as the classification of angina pectoris and its causes. Learn about coronary atherosclerosis, ischemia, and the distribution of coronary arteries in the heart.

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