Vasodilators Quiz

Angina Treatment

• Ranolazine (Ranexa) is the drug of choice for angina due to its long-acting nature.
• Its primary mechanism of action is to inhibit the late sodium current, which reduces the calcium overload in cardiac cells.

Combination Therapy for Angina

• A combination of medications, including nitrates, beta-blockers, or calcium channel blockers, is used to treat angina.

Heart Failure with Reduced Ejection Fraction (HFrEF)

• Sacubitril/Valsartan (Entresto) is an ARNI used to treat heart failure with reduced ejection fraction (HFrEF).
• The medication combination of ACE inhibitors, ARBs, or ARNIs with spironolactone can be used to improve the blockage of RAAS in heart failure.
• SGLT2 inhibitors work by reducing sodium reabsorption and increasing glucose excretion, leading to a decrease in cardiac load and improvement in heart failure outcomes.
• Loop diuretics are recommended for heart failure to maintain euvolemia and relieve congestion.

Alternative Medications

• ARBs are recommended as a substitute for ACE inhibitors if a patient cannot tolerate the dry cough associated with ACE inhibitors.
• Beta-blockers (e.g., carvedilol, metoprolol) are considered part of the guideline-directed medical therapy (GDMT) for heart failure.
• Ivabradine is used to improve outcomes in heart failure and can be added if a patient has acute diastolic heart failure and loop diuretic resistance.
• Clevidipine is indicated for hypertension urgency/emergency and acute diastolic heart failure exacerbation.

Vasodilators

• Sodium nitroprusside has the potential risk of causing cyanide toxicity and needs to be monitored in an ICU setting.
• Hydralazine is contraindicated in renal failure and pregnancy.
• Hydralazine acts directly on the smooth muscle of arterioles via nitric oxide, leading to relaxation and decreased afterload.
• Hydralazine is associated with the risk of SLE and is indicated for hypertension in people of color and heart failure with reduced ejection fraction (HFrEF).
• Minoxidil is known for causing reflex tachycardia and palpitations as side effects.
• Minoxidil is not recommended in glaucoma, migraines, erectile dysfunction (on meds), recent stroke, and creatinine clearance less than 50.
• Sodium nitroprusside has the potential side effect of causing delirium and psychotic behavior due to cyanide toxicity.
• Isosorbide mononitrate is specifically indicated for acute and chronic angina due to its effect on decreasing oxygen demand and dilating the venous system.
• Amlodipine acts on calcium channels and dilates arteries only, and is indicated for hypertension and heart failure especially in people of color.