MAX3301

2024年10月15日星期二

Antianginal Drugs Notes

Definition and Purpose:

Antianginal drugs are medications used to prevent or treat angina pectoris

They work by improving the balance between myocardial oxygen supply and demand

Main Classes of Antianginal Drugs:

a) Nitrates

b) Beta-blockers

c) Calcium channel blockers

d) Potassium channel openers

e) Other agents (e.g., ranolazine)

Nitrates:

Mechanism: Vasodilation, reducing preload and afterload

Examples: Nitroglycerin, isosorbide mononitrate, isosorbide dinitrate

Uses: Acute angina relief and prophylaxis

Key points:

Rapid onset of action (especially sublingual nitroglycerin)

Risk of tolerance with continuous use

Common side effects: headache, hypotension

Beta-blockers:

Mechanism: Reduce heart rate and myocardial oxygen demand

Examples: Metoprolol, atenolol, propranolol

Uses: Angina prevention and treatment

Key points:

Effective for both stable and unstable angina

Contraindications: severe asthma, uncontrolled heart failure

Side effects: fatigue, cold extremities, sexual dysfunction

Calcium Channel Blockers:

Mechanism: Vasodilation and reduction of myocardial contractility

Examples: Amlodipine, diltiazem, verapamil

Uses: Angina prevention, especially in patients intolerant to beta-blockers

Key points:

Dihydropyridines (e.g., amlodipine) primarily cause vasodilation

Non-dihydropyridines (e.g., verapamil) also slow heart rate

Side effects: peripheral edema, constipation, headache

Potassium Channel Openers:

Example: Nicorandil

Mechanism: Vasodilation without affecting heart rate or contractility

Uses: Additional option for chronic stable angina

Key points:

Not widely available in all countries

Can cause headaches and dizziness

Other Agents:

Ranolazine:

Mechanism: Inhibits late sodium current in cardiac cells

Uses: Chronic stable angina

Advantages: Minimal effects on heart rate and blood pressure

Combination Therapy:

Often provides better symptom control than monotherapy

Common combinations:

Nitrate + Beta-blocker

Nitrate + Calcium channel blocker

Beta-blocker + Calcium channel blocker (with caution)

Clinical Considerations:

Individual patient factors (comorbidities, contraindications)

Monitoring for efficacy and side effects

Patient education on proper use and potential adverse effects

Regular follow-up and adjustment of therapy as needed

Non-pharmacological Approaches:

Lifestyle modifications (smoking cessation, exercise, diet)

Stress reduction techniques

Cardiac rehabilitation programs

Emergency Management:

Sublingual nitroglycerin for acute angina attacks

Patient education on when to seek emergency care

Remember: This is a general overview. Always consult current guidelines and prescribing information for detailed and up-to-date information on antianginal drug therapy.

Antianginal Drugs NCLEX Questions

Here's a set of NCLEX-style questions focusing on antianginal drugs to help you prepare for your exam:

A patient with angina is prescribed nitroglycerin sublingual tablets. Which instruction should the nurse provide?

a) Swallow the tablet whole with water

b) Place the tablet under the tongue and allow it to dissolve

c) Chew the tablet before swallowing

d) Apply the tablet to the skin

Answer: b) Place the tablet under the tongue and allow it to dissolve

Which of the following is a common side effect of nitrates?

a) Hyperglycemia

b) Headache

c) Constipation

d) Bradycardia

Answer: b) Headache

A patient taking metoprolol for angina reports feeling tired. What is the appropriate nursing action?

a) Discontinue the medication immediately

b) Increase the dose

c) Reassure the patient this is a common side effect and monitor

d) Switch to a calcium channel blocker

Answer: c) Reassure the patient this is a common side effect and monitor

Which antianginal drug is contraindicated in patients with severe asthma?

a) Amlodipine

b) Isosorbide dinitrate

c) Propranolol

d) Ranolazine

Answer: c) Propranolol

A patient on long-acting nitrates develops tolerance. What is the best approach to manage this?

a) Increase the dose

b) Add a beta-blocker

c) Implement a nitrate-free interval

d) Switch to short-acting nitrates

Answer: c) Implement a nitrate-free interval

Which antianginal drug works primarily by inhibiting the late sodium current in cardiac cells?

a) Verapamil

b) Ranolazine

c) Nitroglycerin

d) Atenolol

Answer: b) Ranolazine

A patient on diltiazem for angina should be monitored closely for which side effect?

a) Hyperkalemia

b) Tachycardia

c) Peripheral edema

d) Increased liver enzymes

Answer: c) Peripheral edema

Which antianginal drug class is most likely to cause cold extremities as a side effect?

a) Nitrates

b) Calcium channel blockers

c) Beta-blockers

d) Potassium channel openers

Answer: c) Beta-blockers

A patient taking isosorbide mononitrate reports dizziness when standing up. What should the nurse advise?

a) Increase fluid intake

b) Take the medication with food

c) Rise slowly from a sitting or lying position

d) Take the medication at bedtime only

Answer: c) Rise slowly from a sitting or lying position

Which antianginal drug is contraindicated with the use of phosphodiesterase-5 inhibitors (e.g., sildenafil)?

a) Metoprolol

b) Amlodipine

c) Nitroglycerin

d) Ranolazine

Answer: c) Nitroglycerin

These questions cover various aspects of antianginal drugs, including their mechanisms of action, side effects, contraindications, and patient education. Remember to always refer to the most current guidelines and drug information when studying for the NCLEX.

Antianginal Drugs Names

Here's a comprehensive list of antianginal drugs, organized by their classes:

Nitrates:

a) Short-acting:

Nitroglycerin (Glyceryl trinitrate)

Isosorbide dinitrate (immediate-release)

Amyl nitrite

b) Long-acting:

Isosorbide mononitrate

Isosorbide dinitrate (extended-release)

Nitroglycerin transdermal patch

Beta-blockers:

a) Cardioselective:

Metoprolol

Atenolol

Bisoprolol

Nebivolol

b) Non-cardioselective:

Propranolol

Nadolol

Timolol

c) With alpha-blocking properties:

Carvedilol

Labetalol

Calcium Channel Blockers (CCBs):

a) Dihydropyridines:

Amlodipine

Nifedipine

Felodipine

Nicardipine

b) Non-dihydropyridines:

Verapamil

Diltiazem

Newer Antianginal Agents:

a) Late sodium current inhibitor:

Ranolazine

b) If channel inhibitor:

Ivabradine

c) Metabolic modulator:

Trimetazidine

Potassium Channel Opener:

Nicorandil (not available in all countries)

Miscellaneous:

a) Vasodilator:

Dipyridamole

b) Selective sinus node inhibitor:

Zatebradine (investigational)

Combination Products:

Isosorbide dinitrate/Hydralazine (BiDil)

It's important to note that while these drugs are classified as antianginal, some of them (particularly beta-blockers and calcium channel blockers) have multiple indications and are widely used in the treatment of other cardiovascular conditions such as hypertension and arrhythmias.

The choice of antianginal drug depends on various factors, including the patient's specific condition, comorbidities, contraindications, and potential drug interactions. Often, a combination of these medications is used to achieve optimal angina management. Additionally, new antianginal drugs are continually being researched and developed, so this list may expand in the future.

Antianginal Drugs Mnemonic_ BORN to Relieve Angina

Antianginal Drugs Mnemonic: BORN to Relieve Angina

Here's a helpful mnemonic to remember the main classes of antianginal drugs:

B - Beta-blockers

O - Other (Ranolazine)

R - Revascularization (not a drug, but an important treatment option)

N - Nitrates and Calcium channel blockers

This mnemonic, ”BORN to Relieve Angina,” provides a quick and easy way to recall the primary categories of antianginal treatments. Let's break down each component and expand on the drugs within these categories:

B - Beta-blockers:

Beta-blockers are a crucial class of antianginal drugs. They work by blocking the effects of adrenaline on the heart, reducing heart rate, blood pressure, and myocardial oxygen demand. Examples include:

Metoprolol

Atenolol

Propranolol

Carvedilol

O - Other (Ranolazine):

Ranolazine is a newer antianginal drug with a unique mechanism of action. It inhibits the late sodium current in cardiac cells, improving diastolic function and reducing myocardial oxygen demand. It's often used when other antianginal drugs are not effective or tolerated.

R - Revascularization:

While not a drug, revascularization procedures are essential treatment options for severe angina. These include:

Percutaneous Coronary Intervention (PCI) with stenting

Coronary Artery Bypass Grafting (CABG)

N - Nitrates and Calcium channel blockers:

This category includes two major classes of antianginal drugs:

Nitrates:

These drugs cause vasodilation, reducing preload and afterload. Examples include:

Nitroglycerin (short-acting)

Isosorbide mononitrate (long-acting)

Isosorbide dinitrate

Calcium Channel Blockers (CCBs):

CCBs reduce calcium influx into vascular smooth muscle and cardiac cells, causing vasodilation and reducing heart rate and contractility. They are divided into two main types:

Dihydropyridines (primarily affect blood vessels):

Amlodipine

Nifedipine

Felodipine

Non-dihydropyridines (affect both heart and blood vessels):

Verapamil

Diltiazem

This mnemonic not only helps in remembering the main categories of antianginal treatments but also emphasizes the importance of considering revascularization in severe cases. It's worth noting that while the mnemonic groups nitrates and calcium channel blockers together, they are distinct classes of drugs with different mechanisms of action.

In clinical practice, these drugs are often used in combination to provide optimal angina management. The choice of drug or combination depends on the patient's specific condition, comorbidities, and response to treatment. Regular assessment and adjustment of the treatment plan are essential for effective angina management.

Antianginal Drugs Mechanism of Action

Antianginal drugs work through various mechanisms to alleviate angina symptoms by either increasing oxygen supply to the heart or decreasing myocardial oxygen demand. Understanding these mechanisms is crucial for effective management of angina pectoris. Here's a detailed look at the mechanisms of action for different classes of antianginal drugs:

Nitrates:

Mechanism: Nitrates are prodrugs that release nitric oxide (NO) in vascular smooth muscle cells. NO activates guanylate cyclase, increasing cyclic GMP levels, which leads to:

Venodilation: Reducing preload and left ventricular end-diastolic pressure

Arterial vasodilation: Reducing afterload

Coronary vasodilation: Improving blood flow to ischemic areas

Inhibition of platelet aggregation

These effects collectively reduce myocardial oxygen demand and increase oxygen supply.

Beta-blockers:

Mechanism: Beta-blockers competitively inhibit the binding of catecholamines to beta-adrenergic receptors, resulting in:

Decreased heart rate

Reduced myocardial contractility

Lowered blood pressure

These effects reduce myocardial oxygen demand and increase diastolic filling time, improving coronary perfusion.

Calcium Channel Blockers:

Mechanism: These drugs block L-type calcium channels in cardiac and vascular smooth muscle cells, leading to:

a. Dihydropyridines (e.g., amlodipine):

Peripheral and coronary vasodilation

Reduced afterload

b. Non-dihydropyridines (e.g., verapamil, diltiazem):

Decreased heart rate

Reduced myocardial contractility

Coronary vasodilation

Both subclasses reduce myocardial oxygen demand and improve oxygen supply.

Potassium Channel Openers (Nicorandil):

Mechanism: Nicorandil has a dual mechanism of action:

Activation of ATP-sensitive potassium channels in vascular smooth muscle, causing vasodilation

Nitrate-like effects, releasing NO and causing venodilation

These actions reduce preload and afterload, decreasing myocardial oxygen demand.

Fatty Acid Oxidation Inhibitors (Trimetazidine):

Mechanism: Trimetazidine inhibits the long-chain 3-ketoacyl-CoA thiolase enzyme, leading to:

Shift from fatty acid oxidation to glucose oxidation in cardiac metabolism

Improved cardiac efficiency and reduced oxygen consumption

This metabolic modulation improves myocardial function without affecting hemodynamics.

If Channel Inhibitors (Ivabradine):

Mechanism: Ivabradine selectively inhibits the funny current (If) in sinoatrial node cells, resulting in:

Reduced heart rate without affecting myocardial contractility or conduction

This decreases myocardial oxygen demand while preserving coronary dilation and contractility.

Late Sodium Current Inhibitors (Ranolazine):

Mechanism: Ranolazine inhibits the late sodium current in cardiac cells, leading to:

Reduced intracellular calcium overload

Improved diastolic relaxation

Enhanced coronary blood flow

These effects improve myocardial oxygen supply-demand balance without significant hemodynamic changes.

Antiplatelet Agents:

Mechanism: While not directly antianginal, these drugs prevent platelet aggregation:

Aspirin: Irreversibly inhibits cyclooxygenase-1 (COX-1), reducing thromboxane A2 production

Clopidogrel: Inhibits ADP-induced platelet aggregation by irreversibly binding to P2Y12 receptors

By preventing thrombotic events, these agents help maintain coronary blood flow.

Antianginal Drugs MCQs

Here's a set of 10 multiple-choice questions (MCQs) to test your knowledge of antianginal drugs:

Which of the following antianginal drugs primarily works by releasing nitric oxide?

a) Metoprolol

b) Nitroglycerin

c) Amlodipine

d) Ranolazine

Beta-blockers reduce myocardial oxygen demand by:

a) Increasing heart rate

b) Decreasing heart rate

c) Increasing contractility

d) Increasing blood pressure

Which class of antianginal drugs can cause reflex tachycardia as a side effect?

a) Beta-blockers

b) Nitrates

c) Dihydropyridine calcium channel blockers

d) Ranolazine

Ranolazine's primary mechanism of action is:

a) Blocking beta-adrenergic receptors

b) Inhibiting the late sodium current

c) Releasing nitric oxide

d) Blocking calcium channels

Which antianginal drug is contraindicated in patients taking phosphodiesterase-5 inhibitors?

a) Metoprolol

b) Amlodipine

c) Nitroglycerin

d) Ranolazine

Calcium channel blockers exert their antianginal effect primarily by:

a) Increasing heart rate

b) Vasodilation

c) Increasing contractility

d) Releasing nitric oxide

Which of the following is a long-acting nitrate?

a) Nitroglycerin sublingual tablet

b) Isosorbide mononitrate

c) Nitroglycerin spray

d) Nitroglycerin ointment

Beta-blockers are contraindicated in patients with:

a) Hypertension

b) Severe bradycardia

c) Angina pectoris

d) Myocardial infarction

Which antianginal drug is most likely to cause ankle edema as a side effect?

a) Metoprolol

b) Isosorbide dinitrate

c) Amlodipine

d) Ranolazine

Tolerance is most commonly associated with which class of antianginal drugs?

a) Beta-blockers

b) Calcium channel blockers

c) Nitrates

d) Ranolazine

Answers:

b) Nitroglycerin

b) Decreasing heart rate

c) Dihydropyridine calcium channel blockers

b) Inhibiting the late sodium current

c) Nitroglycerin

b) Vasodilation

b) Isosorbide mononitrate

b) Severe bradycardia

c) Amlodipine

c) Nitrates

These MCQs cover various aspects of antianginal drugs, including their mechanisms of action, side effects, contraindications, and specific drug characteristics. They help reinforce key concepts about these medications and their use in managing angina pectoris.

Antianginal Drugs MCQs with Answers

Here's a set of Multiple Choice Questions (MCQs) on antianginal drugs, along with their correct answers:

Which of the following is NOT a class of antianginal drugs?

a) Nitrates

b) Beta-blockers

c) Calcium channel blockers

d) ACE inhibitors

Answer: d) ACE inhibitors

Which antianginal drug works primarily by reducing myocardial oxygen demand?

a) Nitroglycerin

b) Metoprolol

c) Amlodipine

d) Ranolazine

Answer: b) Metoprolol

Sublingual nitroglycerin is most commonly used for:

a) Prophylaxis of angina

b) Acute relief of angina

c) Hypertension control

d) Heart failure management

Answer: b) Acute relief of angina

Which antianginal drug is known as a ”metabolic modulator”?

a) Isosorbide dinitrate

b) Diltiazem

c) Ranolazine

d) Propranolol

Answer: c) Ranolazine

The primary mechanism of action for long-acting nitrates is:

a) Increasing myocardial contractility

b) Decreasing heart rate

c) Vasodilation of coronary arteries

d) Blocking calcium channels

Answer: c) Vasodilation of coronary arteries

Which side effect is commonly associated with nitrate use?

a) Bradycardia

b) Headache

c) Hyperkalemia

d) Constipation

Answer: b) Headache

Beta-blockers used in angina treatment work by:

a) Increasing heart rate

b) Decreasing myocardial oxygen demand

c) Dilating coronary arteries

d) Increasing cardiac output

Answer: b) Decreasing myocardial oxygen demand

Which calcium channel blocker is primarily used for its antianginal effects?

a) Nifedipine

b) Amlodipine

c) Verapamil

d) Diltiazem

Answer: d) Diltiazem

Nitrate tolerance can be managed by:

a) Increasing the dose

b) Providing a nitrate-free interval

c) Switching to a different antianginal drug

d) Adding a beta-blocker

Answer: b) Providing a nitrate-free interval

Which antianginal drug is contraindicated in patients taking phosphodiesterase-5 inhibitors (e.g., sildenafil)?

a) Metoprolol

b) Diltiazem

c) Nitroglycerin

d) Ranolazine

Answer: c) Nitroglycerin

The primary mechanism of action for ranolazine is:

a) Blocking sodium channels

b) Dilating coronary arteries

c) Decreasing heart rate

d) Increasing myocardial contractility

Answer: a) Blocking sodium channels

Which antianginal drug class is most likely to cause ankle edema as a side effect?

a) Nitrates

b) Beta-blockers

c) Calcium channel blockers

d) Potassium channel openers

Answer: c) Calcium channel blockers

Ivabradine, a newer antianginal drug, primarily works by:

a) Blocking calcium channels

b) Inhibiting the If current in the sinoatrial node

c) Dilating coronary arteries

d) Reducing myocardial oxygen consumption

Answer: b) Inhibiting the If current in the sinoatrial node

Which antianginal drug is most likely to cause bronchospasm in asthmatic patients?

a) Isosorbide mononitrate

b) Amlodipine

c) Propranolol

d) Ranolazine

Answer: c) Propranolol

The ”first-line” antianginal drug for most patients with stable angina is typically:

a) Nitroglycerin

b) Beta-blockers

c) Calcium channel blockers

d) Ranolazine

Answer: b) Beta-blockers

These MCQs cover various aspects of antianginal drugs, including their mechanisms of action, indications, side effects, and contraindications. They can be useful for medical students, pharmacists, and healthcare professionals to test and reinforce their knowledge about these important medications.

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