32 Questions
What is the main pharmacological action of nitroglycerin?
Dilating vessels and reducing heart loads
What is a clinical use of nitroglycerin?
Angina pectoris
What is a possible adverse reaction of nitroglycerin?
Postural hypotension
What is the mechanism of the effect of isosorbide dinitrate compared to nitroglycerin?
Slower but longer-lasting
What is the main pharmacological action of β-blockers?
Reducing oxygen demand
What is a clinical use of β-blockers?
Stable angina pectoris associated with hypertension or arrhythmias
What is an additional effect of β-blockers?
Improving myocardial metabolism
What can be used to avoid tolerance to nitrates?
Supplementing with agents containing –SH
What is the main cause of cardiac ischemia?
Coronary atherosclerosis
What type of angina is characterized by an imbalance between oxygen demand and supply?
Ischemia (angina pectoris)
What is the primary factor determining myocardial oxygen demand?
All of the above
How do antianginal drugs reduce myocardial oxygen demand?
Reducing contractility
What is the primary way that antianginal drugs increase oxygen supply?
Dilating conduct coronary arteries
What is another effect of antianginal drugs?
Anti-platelet coagulation and thrombus formation
What is the term for the imbalance between oxygen demand and supply?
Ischemia
What is the classification of angina that occurs when the patient is at rest?
Spontaneous angina
What is the recommended approach for dose individualization of antianginal drugs?
Starting from a small dose
What is the effect of nitroglycerin on heart rate?
Markedly increase
What is the effect of verapamil and diltiazem on heart rate and contractility?
Decrease
Which of the following is a clinical use of nifedipine?
Stable angina
What is the effect of β blockers on contractility?
Decrease
What is the mechanism of action of nicorandil?
Opening ATP-sensitive K+ channels
What is the effect of Ca2+ antagonists on wall tension?
Increase or decrease
What is the effect of ACEIs on heart loads?
Decrease
What is the effect of combination therapy on oxygen demand?
Decrease
What is the classification of cardiovascular diseases based on?
Target organs/tissues
Which of the following drugs is similar to beta blockers in its action?
Verapamil and diltiazem
What is the basis of most cardiovascular diseases?
Arteriosclerosis
What is the effect of dipyridamole on platelet aggregation?
Inhibition
What is the recommended approach for withdrawing antianginal drugs?
Gradually and slowly withdrawing the drug
What is the effect of calcium channel blockers on blood pressure?
Decrease
What is the effect of combination therapy with β blockers and nitroglycerin?
Potentiates the antianginal effects
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
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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