Pharmacology of Ischemic Heart Disease (IHD) Practice Flashcards

Comprehensive flashcards covering the pharmacology of Ischemic Heart Disease (IHD), including drug classes, mechanisms of action, administration guidelines, and patient education.

What are the four common classes of drugs used to manage stable angina?

1. Organic nitrates, 2. $\beta$-blockers, 3. Calcium channel blockers, and 4. Sodium channel–blocking drug.

According to the lecture, what are the two main ways antianginal drugs improve blood delivery to the heart muscle?

By dilating blood vessels (increasing the supply of oxygen) or by decreasing the work of the heart (decreasing the demand for $O_2$).

What is the primary mechanism of action of nitrates?

They produce a general vasodilation of systemic veins and arteries, which reduces cardiac work to relieve ischemia and pain.

What is the recommended protocol for using sublingual nitroglycerin during an acute anginal attack?

Administer 1 dose every $5\,min$ for $15\,min$ (total of 3 doses); if pain is not relieved, report to a health care provider.

Which three specific organic nitrates are mentioned in the lecture?

Isosorbide dinitrate [ISD], Isosorbide mononitrate [ISM], and Nitroglycerin [NTG].

What are the onset and duration of action for intravenous (IV) Nitroglycerin?

Onset is $1\text{--}2\,min$ and duration is $3\text{--}5\,min$.

To avoid drug tolerance with nitrates, what is the recommended daily drug-free period?

A $10\text{--}12\,hour$ drug-free period each day (e.g., removing a transdermal patch at night during sleep).

Which formulations of nitrates are least likely to induce tolerance?

Short-acting formulations such as sublingual (SL) NTG, oral NTG spray, and SL ISD.

What are the common adverse effects of nitrate therapy?

Headache (often decreases with continued therapy), hypotension, dizziness, vertigo, weakness, flushing, and local burning/tingling (sublingual) or contact dermatitis (transdermal).

What unique storage requirements exist for sublingual Nitroglycerin tablets?

They must be kept in their original container because they are rapidly degraded by heat, moisture, and light, and they should be replaced $6\,months$ to $1\,year$ after opening.

How do $\beta$-adrenergic blocking drugs function in the heart?

They antagonize $\beta$ receptors to decrease the heart rate and the force of myocardial contractions.

What is the specific exception where $\beta$-blockers are contraindicated and may worsen anginal symptoms?

Vasospastic angina (coronary artery spasm).

Which $\beta$-blocker with intrinsic sympathomimetic activity (ISA) should be avoided in patients with angina or prior MI?

Pindolol.

List the cardio-selective $\beta$-blockers provided in the notes.

Atenolol, betaxolol, bisoprolol, esmolol, acebutolol, metoprolol, and nebivolol.

What is the titration target for heart rate when using $\beta$-blockers for angina?

Resting heart rate of $55$ or $60\,beats/minute$ and a maximum heart rate of $100\,beats/minute$ or less during exercise.

What is the primary effect of Calcium Channel Blockers (CCBs) in treating coronary artery disease?

To block the influx of calcium ions into vascular smooth muscle, causing arteriolar vasodilation and a reduction in blood pressure (afterload).

Which two Calcium Channel Blockers also block calcium influx in cardiac muscle and the SA/AV nodes to decrease heart rate?

Verapamil and diltiazem.

What is the mechanism of action for the sodium channel blocker Ranolazine?

It inhibits the late phase of the sodium current ($\text{late } I_{Na}$), which reduces intracellular sodium and calcium overload, thereby improving diastolic function.

In the treatment algorithm for stable ischemic heart disease, what is the first-line drug therapy added after sublingual nitroglycerin?

A $\beta$-blocker.

Which drug class is contraindicated for patients with asthma or COPD according to the concomitant disease chart?

$\beta$-Blockers (if they are nonselective).