Pharmacology Chapter 23 - Antianginal Drugs

Questions and Answers

What is angina pectoris?

Chest pain that occurs when the heart's supply of blood carrying oxygen is insufficient to meet the demands of the heart.

What is angina?

An imbalance of oxygen supply and demand.

Which type of angina is caused by a chronic narrowing usually due to atherosclerosis?

Chronic stable angina (correct)

Unstable angina

Vasospastic angina

None of the above

What are the three main classes of drugs used to treat angina pectoris?

All of the above Signup and view all the answers

What are the three main therapeutic objectives of antianginal drugs?

<ol> <li>Minimize the frequency of attacks and decrease the duration and intensity of the anginal pain. 2) Improve the patient's functional capacity with as few adverse effects as possible. 3) Prevent or delay the worst possible outcome: myocardial infarction.</li> </ol> Signup and view all the answers

What is the overall goal of antianginal drug therapy?

Increase blood flow to the ischemic myocardium, decrease myocardial oxygen demand, or both. Signup and view all the answers

What are Nitrates/Nitrites mainly used for?

They are the mainstay for angina therapy because they can increase supply and decrease demand. Signup and view all the answers

What is a common adverse effect of Nitrates/Nitrites?

Headache, orthostatic hypotension, reflex tachycardia, dizziness/syncope. Signup and view all the answers

What should patients do to avoid tolerance to Nitrates/Nitrites?

Use the lowest effective dose and take long-acting formulations with an 8-hour nitrate free period. Signup and view all the answers

Which of the following is NOT a contraindication to the use of Nitrates/Nitrites?

Hypertension Signup and view all the answers

What should a patient do if sublingual nitroglycerin (Nitrostat) pain is not relieved in 5 minutes?

Call 911. Signup and view all the answers

How many mg of Isosorbide dinitrate (Isordil) can a patient take sublingually?

5 mg. Signup and view all the answers

What is the dosage range for Isosorbide mononitrate (Imdur)?

60-240 mg/day. Signup and view all the answers

What should Nitro-Bid IV be used with?

Glass bottle and special tubing. Signup and view all the answers

What is important in the patient education for Nitrostat?

Leave the tablet under the tongue until it dissolves and store at room temperature, away from light and moisture. Signup and view all the answers

How should Nitro-dur transdermal patches be applied?

Apply to a non-hairy part of the skin. Signup and view all the answers

Study Notes

Angina Overview

Angina pectoris refers to chest pain resulting from the heart's insufficient blood supply.
Angina represents an imbalance between oxygen supply and demand in the heart.

Types of Angina

Chronic stable angina: Caused by atherosclerosis; occurs predictably with exertion and usually subsides within 15 minutes.
Unstable angina: Acute and can lead to myocardial infarction; may occur at rest.
Vasospastic angina (Prinzmetal): Results from coronary artery vasospasm; can occur unexpectedly at rest.

Antianginal Drugs

Three main classes include:
- Nitrates/Nitrites
- Beta blockers
- Calcium channel blockers

Therapeutic Objectives

Minimize frequency and intensity of angina attacks.
Improve patient functional capacity with minimal side effects.
Prevent or delay myocardial infarction.

Goals of Therapy

Increase blood flow to ischemic myocardium and reduce myocardial oxygen demand.

Nitrates/Nitrites

Primary treatment for angina; increases blood supply and decreases demand.
Common formulations include:
- Nitroglycerin
- Isosorbide dinitrate
- Isosorbide mononitrate

Mechanism of Action

Nitrates act on vascular smooth muscle to dilate veins and arteries, reducing preload and enhancing coronary artery dilation.

Indications

Effective for all forms of angina: stable, unstable, and vasospastic.
Long-acting forms intended for prophylaxis; rapid-acting forms for acute attacks.

Contraindications

Allergy and hypotension.
Increased intracranial pressure and certain drug interactions (e.g., erectile dysfunction medications).
Conditions such as anemia and closed-angle glaucoma.

Adverse Effects

Common effects include headaches, orthostatic hypotension, reflex tachycardia, and dizziness, typically diminishing with use.

Tolerance Management

Rapid tolerance can develop, especially with high doses; manage by using the lowest effective dose and incorporating an 8-hour nitrate-free period.

Drug Interactions

Interactions noted with alcohol, anti-hypertensive medications, and erectile dysfunction treatments.

Specific Nitrates

Isosorbide dinitrate (Isordil): Available sublingually and orally, with dosing instructions emphasizing gradual introduction and storage in a cool place.
Isosorbide mononitrate (Imdur): Sustained-release formulation for constant drug concentration; oral only.
Nitro-Bid IV: Used for continuous infusion, requires special administration equipment.
Nitrostat: Sublingual formulation for acute attacks; rapid onset, short duration.
Patient education for Nitrostat includes taking it at the onset of pain and knowing when to seek emergency help.

Additional Formulations

Nitro-dur: Transdermal patch applied to non-hairy areas.

Patient Education Highlights

For sublingual nitroglycerin: take at pain onset, call 911 if pain persists after two doses, allow the tablet to dissolve under the tongue, and properly store the medication.

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Description

Test your knowledge on antianginal drugs and angina pectoris with this flashcard quiz! Cover key concepts such as types of angina, oxygen supply and demand imbalance, and more. Perfect for students studying pharmacology and related healthcare fields.