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This Concept Map, created with IHMC CmapTools, has information related to: Antianginal Drugs, Antianginal Drugs Piperazine Derivative RANOLAZINE MOA - inhibit late inward Na+ channel -more open during ischemia ->elevated intracell Na+ ->exchange for Ca++ ->increased wall tension -dec'd perfusion -Rx inhibits Ca++ increase -less tension, less ATP needed -less tension on vessels->perfusion -selective for damaged tissue -NO increase in HR or BP in NL ADRs -Prolong QT interval (->torsades) -dizziness, syncope, HA, nausea, constipation Use -add-on therapy, Antianginal Drugs DRUG OF CHOICE beta-blockers METOPROLOL PINDOLOL atenolol PROPRANOLOL Effects - more time in diastole Improve subendocard flow -preferentially perfuses ischemic Decrease HR, contractility -additive effects w/ nitrates -can be DANGEROUS in CHF pts Use - TYPICAL ANGINA (not acute attack) ->prevent inc'd dmd during exercise ->prevent reflex tachy from nitrates or dihydropyridines - if prior MI - proven to reduce V arrhyth Verapamil+Beta-blocker=> -decrease contractility TOO MUCH -can use beta-blocker + DILTIAZEM, Antianginal Drugs Goals Increase CO: -Digitalis, + inotropes Reduce cardiac work: -rest: physical, mental -manipulate Na+ -reduce preload, afterload, Antianginal Drugs BiDil isosorbide/ hydralazine MOA -iso=>relax venous sm mm -hydral=>relax aa sm mm ->reduce preload, afterload -adjunct for CHF in black pts ->dec hospitalizations, mort ->inc pt fcnal status ADRs -malaise, cholecystitis, hypoTN -angioedema, HA, dizziness, -chest pain, asthenia, nausea -bronchitis, high cholesterol, Antianginal Drugs Tx Strategies STABLE ANGINA -increased O2 dmd -chest pain during exertion -same Sx each time Prevent MI ASA Statins beta-blockers, CCB (if HTN) (beta-blocker if prior MI) (CCB if DM, asthma) ->decrease O2 dmd ACE-I Clopidogrel - anti-platelet agg Long-acting Nitrates (esp if CHF) Ranolazine?? CABG or angioplasty Abort Attack Nitroglycerin prn, Antianginal Drugs Inhibition of RAAS CAPTOPRIL LOSARTAN-no cough Decrease blood volume (inhibit aldost, ADH release) Vasodilation (vv, aa) ->decrease PRE-. AFTERLOAD For MI - inhibit Ang-II remodeling, Antianginal Drugs Tx Strategies UNSTABLE ANGINA -plaque rupture -plt aggregation O2 dmd>supply -crescendo of Sx -often forerunner of MI Prophylaxis -ASA -beta-blockers -CCBs less effective, Antianginal Drugs Ca++ Channel Blockers Dihydropyridines: NIFEDIPINE, amlodipine DILTIAZEM VERAPAMIL MOA - block L-type Ca++ channels -smooth mm relaxation Effects Increase diastolic filling time Reduce plt agg Inhibit adrenergic xmission Decrease preload, afterload -esp ARTERIAL-> dec. AFTERLOAD Inhibit cor vasospasm Delay adenosine breakdown Protect against anoxia ADRs reduce BP too much->reflex tachy (dihydropyridines)-give b-blocker D & V depress SA, AV, contractility more - DON'T GIVE IF CHF -also->constipation->dig toxicity -give less DIGOXIN Fatigue, HA, dizziness, flushing, periph edema Gingival hyperplasia, Antianginal Drugs Tx Strategies VARIANT (Prinzmetal) ANGINA -acute cor aa spasm -chest pain at rest Use vasodilators Nitrates CCBs (verapamil), Antianginal Drugs Antiplatelet Drugs ASA ticlodipine abciximab Prevent stroke or MI w/ H/O suspected or real MI or in UNSTABLE ANGINA -prevent plt aggregation, Antianginal Drugs Organic Nitrates NITROGLYCERIN isosorbide dinitrate MOA ->NO->stim GC->increase cGMP ->inhibit myosin kinase ->inhibit sm mm contraction -VENODILATION>>aa dilation -DEC PRELOAD>>dec afterload ->improve subendocard flow -relieve coronary aa spasm Use - ALL forms of administration -ORAL-isosorbide -tablet stability decreased via: -light, plastic containers, friability, body heat, shelf life -lots of first-pass metabolism -so sublingual a good route ADRs -vasc sm mm effects->HA, syncope, flushing, reflex tachycardia Tolerance - cellular, physiological -release less NO->less effect