Term
|
Definition
| caused by atherosclerotic obstruction in large coronary arteries; aka effort or stable; usually occurs when exercising |
|
|
Term
| variant angina or Prinzmetal's angina |
|
Definition
| reversible vasospastic reduction of flow in large coronary arteries |
|
|
Term
| unstable or crescendo angina |
|
Definition
| combines atherosclerotic plaque & vasospasm; results from sudden marked platelet aggregation with clot formation at site of a ruptured plaque; occurs at rest as well as during exertion; immediate precursor of myocardial infarction |
|
|
Term
| Primary causes of anginal pain |
|
Definition
| coronary O2 delivery is inadequate to meet myocardial oxygen demand |
|
|
Term
| nitrates - nitroglycerin (Minitran, Nitrostat), isosorbide dinitrate (Isordil) |
|
Definition
| duration of action from minutes to hours; sublingual tabs or transdermal patches or oral tabs; Uses: treatment of acute anginal attacks after onset, prevention of attacks before onset; rapidly denitrated in liver; first-pass effect is high; |
|
|
Term
| nitrates - nitroglycerin (Minitran, Nitrostat), isosorbide dinitrate (Isordil) |
|
Definition
| MoA: converts to NO --> increases cGMP --> smooth muscle cell relaxation (more venous than arterial) --> peripheral vascular dilation --> reduced preload & reduced afterload; rapidly reduces myocardial cell tension & O2 demand --> reduction in cardiac O2 demand; Clinical Use: treats all 3 types of angina; ADRs: orthostatic postural hypotension, headache, reflex tachycardia & contractility, Na & water retention, tolerance, rebound angina; D-D Interaction: phosphodiesterase-5 inhibitors (Viagra, Cialis, Levitra) --> fatal hypotensive interaction |
|
|
Term
| CCBs - dihydropyridines - nifedipine (Procardia XL), amlodipine (Norvasc) |
|
Definition
| block L-type Ca channels in arterial vascular smooth muscle; prevents all types of angina, treats acute anginal attacks after onset; reduction in afterload & reduce in cardiac oxygen demand; also can reverse vasospasm in coronary arteries; ADRs: reflexly increase heart rate & contractility |
|
|
Term
| CCBs - verapamil (Isoptin SR, Calan), diltiazem (Cardizem) |
|
Definition
| blocks L-type Ca channels in cardiac muscle; reduce cardiac rate & contractility --> reduce cardiac oxygen demand; used for preventative treatment of all forms of angina; ADRs: CHF, AV blockade, sinus rate depression |
|
|
Term
| beta-blockers - metoprolol (Lopressor, Toprol-XL), atenolol (Tenormin), nadolol (Corgard), propanolol (Inderal-LA), timolol |
|
Definition
| competitive antagonists of beta-adrenergic receptors; especially beta receptors in SA node & ventricules of heart: decreases HR, cardiac contractile force, arterial BP, direct inhibitory effect on HR & contractility --> reduces cardiac O2 demand; Uses: preventative tx of angina, effective in preventing exercise-induced angina; useful in treating "silent" ischemia; used in combo with nitrates; ADRs: sinus bradycardia, AV blockade, rebound angina or HTN, asthmatic attacks, masking of tachycardia during hypoglycemic events, sedation, fatigue, sleep alterations |
|
|
Term
|
Definition
| fatty acid oxidation inhibitor; MoA: 1) shift source of fuel used by myocardium from FAs to glucose which demands less O2 --> increased efficiency of O2 utilization; 2) selective inhibition of increased "late" inward-directed Na current caused by myocardial ischemia --> reduce ischemia-induced Ca overload & O2 demand; Uses: tx chronic stable angina with other products; ADRs: dizziness, HA, nausea, constipation, prolong cardiac QT interval |
|
|
