Notes in anti-anginals

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Published	09/08/2024	angina occurs when {{c1::myocardial oxygen demand exceeds myocardial oxygen supply }}
Published	09/08/2024	angina occurs whenever there is an {{c1::occlusive atherosclerotic plaque }} and when {{c1::myocardial oxygen demand exceeds myocardial oxygen su…
Published	09/08/2024	to treat stable ischemic heart disease, {{c1::guideline-directed medical therapy}} with ongoing pt. education is recommended. If patient is havin…
Published	09/08/2024	{{c1::heart rate}}, {{c1::wall force}}, and {{c1::preload}} are major determinants of o2 demand
Published	09/08/2024	(5) {{c1::arterial PO2, Hgb, coronary flow, microcirculation, and O2 extraction}} affect the myocardial oxygen supply
Published	09/08/2024	{{c1::Beta blockers}} and {{c1::Non-dihydropyridine (NDHP) CCBs}} decrease HR which decrease O2 demand
Published	09/08/2024	(2) {{c1::BBs adn ACE/ARBS}} decrease ventricular wall force which decrease o2 demand
Published	09/08/2024	{{c1::Nitrates}} decrease preload which decrease o2 demand
Published	09/08/2024	2 {{c1::nitrates and Dihydropyridine (DHP) CCB}}s increase coronary flow which increase o2 supply by coronary artery vasodilation
Published	09/08/2024	{{c1::BBs}} are the first line therapy for CAD
Published	09/08/2024	{{c1::Metoprolol}}  is the oldest BB so it is well studied in managing pts in stable ischemic heart disease and is the go to drug for stable angi…
Published	09/08/2024	{{c1::BB}} increase survival in pts with heart attacks and help people live longer
Published	09/08/2024	{{c1::BBs}} decrease myocardial oxygen demand by decreasing (3) {{c2::contractility, decreasing HR, and may even decrease wall tension }}
Published	09/08/2024	BBs may also be used for (3) {{c1::AFib w/RVR, HFrEF or (carvedilol, bisoprolol, metoprolol), HFpEF}}
Published	09/08/2024	BBs are titrated until {{c2::maximally at targeted dose}}. the goal is to have HR at {{c1::60-70}} bpm.
Published	09/08/2024	BBs are gradually increased {{c1::daily}} in the hospital or {{c1::weekly}} in outpatient
Published	09/08/2024	adverse drug effects of {{c1::BBs}} are fatigue, lethargy, confusion, depression
Published	09/08/2024	contraindications for BBs are {{c1::hypotension}} and {{c1::bradycardia }}, {{c1::decompensated HF}}, and {{c1::active bronchoconstriction (asthm…
Published	09/08/2024	{{c1::CCBs}} are used in addition to BBs or used as a substitute if pt cannot tolerate BBs or failed BB therapy
Published	09/08/2024	{{c1::DHP CCBs}} would be avoided in AMI, HTNsive emergencies and critical AS
Published	09/08/2024	{{c1::amlodipine}} is generally the most used DHP CCB because it is long acting and generally well tolerated
Published	09/08/2024	nitrates increase coronary blood flow by {{c1::vasodilating coronary arteries}} and decrease preload by making more blood {{c2::stay out in the body}}…
Published	09/08/2024	MOA of nitrates/NTGs is that they increase {{c1::cyclic GMP}} for {{c1::sulfa hydryl groups (r-SH)}} which increase vasodilation
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Published	09/08/2024	the major anti-ischemic mechanism of nitrates/NGTs is that at low doses it decreases {{c1::preload}} and decreases {{c1::myocardial o2 demand}} in the…
Published	09/08/2024	at high doses, nitrates decreases {{c1::afterload}} and decreases {{c1::myocardial o2 demand}} in the {{c1::arteries}} (resistance vessels)
Published	09/08/2024	in the heart, nitrates increase o2 supply by dilating {{c1::large epicardial coronary arteries}}
Published	09/08/2024	Nitrates/NTG: {{c1::↑}} intracellular cGMP *venodilator ={{c2::↓ preload, ↓ O2 demand}} systemic arterial vasodilator = {{c4::↓ afterl…
Published	09/08/2024	quick acting nitrates are used for {{c1::acute episodes of chest pain}} and not for {{c1::daily}} use
Published	09/08/2024	ISDN ={{c1::Isosorbide DiNitrate}}
Published	09/08/2024	the most common adverse drug effect of nitrates is {{c1::headaches}}
Published	09/08/2024	2 {{c1::BP and HR}} should be monitored with administration of nitrates
Published	09/08/2024	ISMN = {{c1::Isosorbide MonoNitrate}}
Published	09/08/2024	ISMN and ISDN are clinically the {{c1::same}}, however {{c1::ISMN}} is typically used more because it is administered once a day as opposed to twice&n…
Published	09/08/2024	longer acting nitrates include a(3) {{c1::SR, patch, and oral (ISMN)}}
Published	09/08/2024	ISDN is available {{c1::SR (longer acting) and tablet form (shorter acting)}}
Published	09/08/2024	long acting nitrates are used for {{c1::chronic management for CP relief/prevention }}
Published	09/08/2024	nitrate tolerance occurs when there is a {{c1::depletion of sulfa hydrate group}} because of chronic, continuous exposure to nitrates in the body…
Published	09/08/2024	nitrates are contraindicated if a patient has used {{c1::-nafils (such as viagra)}}  in the last 24 hours due to synergistic effect of decrease i…
Published	09/08/2024	do not use nitrates in pts with {{c1::preload dependent}} pathologies such as {{c2::right ventricular infarcts}} or {{c2::critical aortic valve stenos…
Published	09/08/2024	{{c2::No}}evidence of survival benefit in CAD for nitrates, only {{c1::symptomatic relief}}
Published	09/08/2024	Ranolazine (Ranexa®) inhibits late {{c1::Na+ entry}} into cell/prevents {{c1::Ca+2 overload}} in myocytes
Published	09/08/2024	{{c1::Ranolazine (Ranexa®)}} is a hemodynamically neutral drug so it does not affect HR or BP or contractility
Published	09/08/2024	{{c1::Ranolazine}} is used as an add on therapy if pts have failed another anti-anginal or despite being on BB or Nitrate therapy still having angina(…
Published	09/08/2024	ranolazine is administered {{c1::500-1000mg twice daily}}
Published	09/08/2024	there are lots of drug interactions with ranolazine because it acts as a {{c1::CYP 3A4 substrate & inhibitor}}{{c3::DHPs, Statins, and SSRIs}} are…
Published	09/08/2024	ranolazine may cause {{c1::QTc interval prolongation }}
Published	09/08/2024	first line treatment for prinzmetal's angina is {{c1::nitrates}} and {{c1::CCBs}}. Avoid {{c1::BBs}}.
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Published	09/08/2024	ACEI/ARBs indirectly decrease o2 demand by decreasing myocardial {{c1::ventricular wall tension}} and by decreasing the {{c1::amount of force}} the ve…
Published	09/08/2024	aspirin inhibits {{c1::thromboxane a2}} cascade. it {{c1::irreversibly}} posions the PLTs.
Published	09/08/2024	{{c2::thienopyridines}} {{c1::irreversibly}} block {{c1::ADP (p2y12)}} by disulfide bonds
Published	09/08/2024	{{c2::nonthienopyridines}} bind {{c1::reversibly}} to block {{c1::ADP (p2y12) }}
Published	09/08/2024	{{c1::Clopidogrel, Prasugrel}} are thienopyridines
Published	09/08/2024	{{c1::Ticagrelor and cangrelor}} are nonthienopyridines
Published	09/08/2024	{{c1::clopidogrel and prasugrel}} are prodrugs
Published	09/08/2024	the anti-platelet drug with the quickest onset is {{c1::aspirin}} (5 min)
Published	09/08/2024	{{c1::prasugrel}} has the longest antiplatelet duration of 7 days as opposed to 5
Published	09/08/2024	ADRs of {{c1::clopidogrel}} are Rash, Thrombocytopenic Thrombotic Purpura (TTP)
Published	09/08/2024	ADRs of {{c1::aspirin}} are GI upset, angioedema
Published	09/08/2024	ADRs of {{c1::prasugrel}} are Rash and you would want to avoid use in TIA/stroke, age>75,  <60kg
Published	09/08/2024	ADRs of {{c1::ticagrelor}} are dyspnea, ↑ {{c2::SCr}}, ↑ {{c2::uric acid}},
Published	09/08/2024	indications for {{c1::ticagrelor}} are ACS (med management or PCI with stent)
Published	09/08/2024	indications for {{c1::prasugrel}} are ACS: Percutaneous Coronary Intervention (PCI) with stent
Published	09/08/2024	indications for {{c1::clopidogrel}} are ACS (med management or PCI/stent), PAD, thrombotic stroke
Published	09/08/2024	indications for {{c1::aspirin}} are ACS, Chronic Stable Angina, stroke prophylaxis, Peripheral Arterial Disease (PAD)
Published	09/08/2024	drugs with survival benefit are (5) {{c1::aspirin, clopidogrel, BBs, ACEIs, and statins }}
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