Chapter 54

Question 1

ANGINA PECTORIS
-What is this?

Answer 1

Sudden pain beneath the sternum, often radiating to the left shoulder or arm

Question 2

ANGINA PECTORIS
-Why does this happen?

Answer 2

Because oxygen supply to the heart is insufficient to meet oxygen demand

Question 3

DRUGS FOR ANGINA PECTORIS
-What are the 3 families of antianginal agents & drug examples

Answer 3

1. Organic nitrates: nitroglycerin
2. Beta blockers: metoprolol
3. CCBs: Verapamil

Question 4

DRUGS FOR ANGINA PECTORIS
-What is the mainstay of treatment?

Answer 4

Nitroglycerin (organic nitrates)

Question 5

DRUGS FOR ANGINA PECTORIS
-What is a newer drug?
-It has limited _____
-Can it be combined with other drugs?

Answer 5

-Ranolazine
-indications
-Yes

Question 6

METOPROLOL
-What is the drug class?

Answer 6

Beta blocker

Question 7

METOPROLOL
-What is the therapeutic use?

Answer 7

Stable angina

Question 8

METOPROLOL
-What does this do?

Answer 8

It decreases O2 demand by decreasing HR & contractility

Question 9

METOPROLOL
-As a result, what effect does this have?

Answer 9

It will increase exercise tolerance & lower the frequency and intensity of anginal attacks

Question 10

METOPROLOL
-What is the route?

Answer 10

PO/IV

Question 11

METOPROLOL
-How is it excreted?

Answer 11

In urine

Question 12

METOPROLOL
-What are the **ADVERSE EFFECTS*? (3)

Answer 12

1. Asthmatic effects (bronchospasm)
2. Bradycardia
3. Decreased AV conduction & contractility

Question 13

METOPROLOL
-This medication should be used cautiously in which patients?

Answer 13

those with diabetes

Question 14

What is the prototype organic nitrate?

Answer 14

Nitroglycerin

Question 15

NITROGLYCERIN
-What is this used for?

Answer 15

Stable & variant angina

Question 16

NITROGLYCERIN: Mechanism of action
-What is it primarily?
-What does this relieve?

Answer 16

-Vasodilator
-pain

Question 17

NITROGLYCERIN: Mechanism of action
-What does it act directly on?
-Why?

Answer 17

-Vascular smooth muscle
-To promote vasodilation

Question 18

NITROGLYCERIN: Adverse Effects
-What are the 3 adverse effects of this medication? (HOR)

Answer 18

-Heachaches
-Orthostatic hypotension
-Reflex tachycardia

Question 19

NITROGLYCERIN: Adverse Effects
-Why does it cause reflex tachycardia?

Answer 19

Because nitroglycerin causes vasodilation, which lowers BP –> baroreceptors will then cause reflex tachycardia

Question 20

NITROGLYCERIN: Drug Interactions
-DO NOT use this with what?
-Why?
-What is an example?

Answer 20

-Phosphodieterase type 5 (PD5) inhibitors
-It can cause life threatening hypotension from vasodilation
-Sildenafil (viagra)

Question 21

NITROGLYCERIN: Drug Interactions
-Use this cautiously with what other medications?

Answer 21

Hypotensive drugs

Question 22

NITROGLYCERIN: Drug Interactions
-What drugs may suppress reflex tachycardia, BUT should still be monitored? (3)

Answer 22

1. Beta blockers
2. Verapamil
3. Diltiazem

Question 23

NITROGLYCERIN: Tolerance
-Tolerance develops (fast/slow)

Answer 23

FAST!!

Question 24

NITROGLYCERIN: Tolerance
-Tolerance MAY develop in which patients?
-What should you do to prevent this?

Answer 24

-Those who are on it long term
-Use the lowest effective dose

Question 25

**NITROGLYCERIN**: *Prepations/Routes* -What are 7 types of preparations/formulations? SSTTTIV

Answer 25

1. Sublingual tablets 2. Sustained release oral capsules 3. Transdermal delivery systems (patch) 4. Tanslingual spray 5. Topical ointment 6. IV infusion 7. Long-acting preparations

Question 26

**NITROGLYCERIN**: *Prepations/Routes* -In terms of the transdermal patches, what 3 things are important to keep in mind?

Answer 26

1. Take them off at night 2. Rotate sites 3. Use area without hair

Question 27

**NITROGLYCERIN**: *Prepations/Routes* -When can a translingual spray be used?

Answer 27

Before exertion, during or before attack

Question 28

**NITROGLYCERIN**: *Prepations/Routes* -Where are IV infusions usually used? -Why?

Answer 28

-In perioperative settings -to help with BP control & HF due to MI

Question 29

**NITROGLYCERIN**: *Prepations/Routes* -How are long-acting preparations discontinued?

Answer 29

Slowly

Question 30

**NITROGLYCERIN**: *Prepations/Routes* -You want to allow for an ____-____ hour drug free period per day

Answer 30

8-12

Question 31

**RANOLAZINE** -This belongs to a first new class of _____ agents approved in more than ___ years -The exact mechanism is unknown (T/F)

Answer 31

-antianginal -25 -TRUE!

Question 32

**RANOLAZINE** -This is a _____-line therapy -It is often combined with ____-line agents for what?

Answer 32

-first -first; inadequate response to other first-line medications

Question 33

**RANOLAZINE** -What is this used for?

Answer 33

Stable angina

Question 34

**RANOLAZINE**: *Mechanism of Action* -What does it allow the heart to do?

Answer 34

Use energy more efficiently by reducing sodium & calcium accumulation

Question 35

**RANOLAZINE** -What are the 2 adverse effects?

Answer 35

1. **QT prolongation** 2. HTN

Question 36

**RANOLAZINE** -With QT prolongation, what is there a higher risk of?

Answer 36

Dysrhythmias

Question 37

**RANOLAZINE** -What are the 3 drug interactions?

Answer 37

1. CYP3A4 inhibitors 2. QT drugs 3. CCBs (except amlodipine)