Pharmacology of Angina + MI

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Author:
mstengs
ID:
189065
Filename:
Pharmacology of Angina + MI
Updated:
2012-12-12 14:52:19
Tags:
Pharmacology Angina MI
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Pharmacology of Angina + MI
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  1. Nitrovasodilators

    - MOA
    - Effect
    - AE
    - Interactions
    • - MOA: releases NO into smooth muscle; activates guanylyl cylase; increases cGMP; increased Ca sequestration into SR; smooth muscle relaxation & vasodilation
    • - Effect: vasodilation of arteries & veins reduce afterload & preload (decrease O2 demand, decrease wall stress)

    • - AE: hypotension, reflex tachycardia, tachyphylaxis (tolerance)
    • - Interactions: lethal hypotension + Sildenafil (erectile dysfxn)
  2. Nitroglycerin
    - Nitrovasodilator
  3. Isosorbide dinitrate (ISDN)
    - Nitrovasodilator
  4. Calcium Channel Blockers (CCB's)

    - MOA
    - Effect
    - AE
    - Contraindication
    - Interactions
    • - MOA: bind to α1 subunit of L-type calcium channel in smooth muscle; inhibit calcium influx; decrease intracellular calcium levels; decrease contractile force of myocardium
    • - Effect: decrease myocardial contractility

    • - AE: hypotension, constipation, gingival hyperplasia, AV node depression¬†
    • - Contraindication: CHF (exc. Amlodipine)
    • - Interactions: CYP3A4 drugs
  5. Nifedipine
    • - CCB
    • - Dihydropyridine
  6. Amlodipine
    • - CCB
    • - Dihydropyridine
    • - Only CCB not contraindicated in CHF
  7. Diltiazem
    • - CCB
    • - Non-dihydropyridine
    • - Extensive CYP3A4 interactions
  8. Verapamil
    • - CCB
    • - Non-dihydropyridine
    • - Extensive CYP3A4 interactions
    • - Higher incidence of constipation
  9. Beta Blockers

    - MOA
    - Effects
    - Contraindications
    - Warning
    - Indications
    • - MOA: competitive antagonist of beta-adrenergic receptors
    • - Effect: block sympothetic increases of HR, BP, & contractility; decrease O2 demand

    • - Contraindications: asthma, uncompensated heart failure, cardiogenic shock
    • - Do not stop abruptly
    • - Indicated in pt's post-MI with angina
  10. Propranolol
    - BB, Nonselective
  11. Metoprolol
    - BB, Selective for B1
  12. Late sodium current inhibitor

    - MOA
    - Effect
    - Interactions
    - Warning
    - Indication
    • - MOA: inhibits late sodium current; decreases intracellular calcium levels, decreases contract contractility
    • - Effect: decrease myocardial contractility

    • - Interactions: CYP3A4
    • - Warning: prolongs QT interval (worry about arrhythmias)
    • - Indication: rx chronic angina
  13. Ranolazine
    - Late sodium current inhibitor (only one)
  14. MONA
    (management of acute MI)
    M - Morphine: blocks pain -/-> anxiety -/-> sympathetic ns -/->  elevated HR, BP, contractility -/-> worsened ischemia -/-> more pain -/-> etc.

    O - Oxygen (nasal): support blood oxygen levels

    N - Nitroglycerin: vasodilation of arterial --> reduced afterload --> reduced wall stress; AND vasodilation of veins --> reduced preload

    A - Aspirin: anti-platelet therapy
  15. Atheroprotective Pharmacology
    - Statins are the only drug class known to have atheroprotective properties

    • - ACE Inhibitors also have been shown to reduce mortality to MI (also lower BP, thus decrease risk factor for atherogenesis)
    • - Amlodipine (CCB) has been shown to reduce mortality in pt's with CAD & in HF pt's

    • - All atheroprotective drugs are shown to increase NO
    • - Exercise also increases NO

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