[PCOL] Part 3.2 - Cardiovascular Drugs - Drugs for Angina Pectoris

e. None

True about Angina Pectoris except:

a. Medical term for chest pain

b. Oxygen demand - supply mismatched

c. In oxygen demand, related organ is the heart

d. In oxygen supply, related organ is the coronary artery

e. None

f. All

Goal of therapy for angina pectoris.

a. To restore the balance between oxygen supply and demand in the ischemic region of the myocardium

b. Lower myocardial oxygen demand

c. Increase oxygen supply

d. a and b

e. b and c

f. All

a. Classic angina

Occurs when oxygen demand exceeds oxygen supply, usually because of diminished coronary flow.

a. Classic angina

b. Vasospastic angina

b. Vasospastic angina

Results from reversible coronary vasospasm that decreases oxygen supply and occurs at rest.

a. Classic angina

b. Vasospastic angina

b. Vasospastic angina

Angina that occur at rest.

a. Classic angina

b. Vasospastic angina

a. True

Antianginal agents can be vasodilators or non vasodilators.

a. True

b. False

f. All

Anti-anginal agents.

a. Nitrates

b. CCBs

c. Beta blockers

d. a and b

e. b and c

f. All

d. a and b

Nitrates

CCBs (specifically, DHP)

Vasodilators anti-anginal agents.

a. Nitrates

b. CCBs

c. Beta blockers

d. a and b

e. b and c

f. All

d. a and b

Anti-anginal agents that target the blood vessels.

a. Nitrates

b. CCBs

c. Beta blockers

d. a and b

e. b and c

f. All

e. b and c

non-DHP CCBs

Beta-blockers

Anti-anginal agents that target the heart.

a. Nitrates

b. CCBs

c. Beta blockers

d. a and b

e. b and c

f. All

f. All

Beta blockers for angina.

a. Targets the heart

b. Have the ability to lower oxygen demand by being cardiac depressants

c. Useful in Classic Angina

d. a and b

e. b and c

f. All

b. Conversion of by nitrates to nitric oxide is through nitric oxide synthase (enzyme) which is thiol (-SH) requiring

nitrates → nitric oxide by aldehyde dehydrogenase isoform

Nitrates MOA except:

a. When taken, it is converted to nitric oxide eventually

b. Conversion of by nitrates to nitric oxide is through nitric oxide synthase (enzyme) which is thiol (-SH) requiring

c. Nitric oxide activates the enzyme Guanylate cyclase (+GC)

d. Increased GC increase cGMP levels which is a well-known messenger than causes relaxation of the blood vessels

e. None

a. Thiol group (SH)

Nitric oxide synthase requires what group?

a. Thiol group (SH)

b. Ester group

c. Thioester group

d. Carboxyl group (COOH)

e. Alcohol group (OH)

f. All

c. I, II, IV, V

Arteriolar Vasodilation is effect at high dose.

Low dose nitrates.

I. Venodilation

II. Veins are relaxed

III. Arteriolar Vasodilation

IV. Preload of the heart lowers reducing oxygen demand

V. For effort angina

a. I, II, III, IV, V

b. I, II, III

c. I, II, IV, V

d. II, III, IV

e. I, II

f. III, IV

c. I, II, IV, V

AFTERLOAD (only) of the heart lowers increasing oxygen supply.

High dose nitrates

I. Arteriolar Vasodilation

II. Arteries are relaxed

III. Preload and afterload of the heart lowers increasing oxygen supply

IV. Vasospastic

V. For Prinzmetal angina

a. I, II, III, IV

b. I, II, III

c. I, II, IV, V

d. II, III, IV, V

e. I, II

f. III, IV

c. Both

→ beta-blockers would decrease the oxygen demand and heart rate

Nitrates at high dose.

a. Drawback is Reflex tachycardia which can lead to Angina attack

b. High dose must be combined with beta blockers.

c. Both

d. None

b. Beta blockers

To avoid tachycardia, nitrates at high doses when used for Prinzmetal angina must be combined with what?

a. Alpha blockers

b. Beta blockers

c. Calcium channel blockers

d. a and b

e. b and c

f. All

a.

Very Short-acting nitrates.

a.

b. 10-30 min

Short-acting nitrates.

a.

c. 6-8 hr

Intermediate-acting nitrates

a. <5-10 min

b. 10-30 min

c. 6-8 hr

d. 10-24 hr

d. 10-12 hr

Long-acting nitrates.

a. <5-10 min

b. 10-30 min

c. 5-8 hr

d. 10-12 hr

Amyl nitrite inhalational

Very short-acting nitrates drugs

NTG SL

ISDN SL

Short-acting nitrate drugs

NTG PO

ISDN PO

Intermediate-acting nitrate drugs

NTG patch

ISMN PO

Long-acting nitrates drugs

e. I, II, III, IV, V

amyl nitrite & sodium nitrite: vs. cyanide toxicity

Clinical uses of nitrates.

I. Mgt of Angina Pectoris

II. Alternative in the Mgt of Hypertensive Emergency

III. Add-on in the Mgt of CHF

IV. Mgt of Acute Pulmonary Edema

V. Initial Mgt of Cyanide Poisoning

a. I, II, III,

b. III, IV, V

c. I, II, III, IV

d. II, III, IV, V

e. I, II, III, IV, V

c. ISDN

Add-on to hydralazine in the Mgt of CHF effective for African-Americans.

a. Amyl nitrite

b. Amyl nitrate

c. ISDN

d. ISMN

a. Amyl nitrite

Used for initial Mgt of Cyanide Poisoning.

a. Amyl nitrite

b. Amyl nitrate

c. ISDN

d. ISMN

e. None

Adverse effects of nitrates except:

a. Tolerance - Monday Disease

b. Vascular/Throbbing HA

c. Reflex Tachycardia

d. Postural hypotension

e. None

a. Nitrates

Contraindicated to PDE-5 Inhibitors such as Sildenafil, Tadalafil, Vardenafil as it may cause fatal hypotension.

a. Nitrates

b. Calcium channel blockers

c. Beta blockers

d. Alpha blockers

e. None

a. Erectile dysfunction

ex. Sildenafil

PDE-5 Inhibitors are used for:

a. Erectile dysfunction

b. Hypotension

c. Hypertension

d. Diabetes

e. Hyperlipidemia

f. All

Beta blockers used for angina

a. Cardiac depressants

b. First line maintenance treatment for Chronic Stable Angina Pectoris (CSAP)

c. Prevent reflex tachycardia associated with nitrovasodilators at high doses

d. a and b

e. b and c

f. All

c. Beta blockers

First line maintenance treatment for Chronic Stable Angina Pectoris (CSAP).

a. Nitrates

b. Calcium channel blockers

c. Beta blockers

c. Both

CCBs for angina.

a. Reduce myocardial oxygen requirements

b. Relieve and prevent the focal coronary artery spasm involved in variant angina

c. Both

d. None

a. Verapamil - as cardio selective CCB

Reduce myocardial oxygen requirements

a. Verapamil

b. Dihydropyridines

b. Dihydropyridines - as vasoselective CCB

Relieve and prevent the focal coronary artery spasm involved in variant angina.

a. Verapamil

b. Dihydropyridines

d. Nifedipine

Short acting DHP CCBs are contraindicated to angina.

Long-acting DHP CCBs (intrinsic or modified) are used for prinzmetal angina.

CCB used for prinzmetal angina except:

a. Lecarnidipine

b. Amlodipine

c. Lacidipine

d. Nifedipine

e. None

b. NSTEMI

Non-ST-elevation ACS characterized by elevated troponin levels indicating myocardial necrosis.

a. Unstable Angina

b. NSTEMI

c. STEMI

d. Stable IHD

c. Unstable Angina

Non-ST-elevation ACS characterized by normal cardiac biomarkers (normal troponin).

a. NSTEMI

b. STEMI

c. Unstable Angina

d. Stable IHD