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Anti-anginal Drugs

USMLE Step 1

DrugMOA & ADRs
3 Classes of Anti-anginal Drugs 1. Nitrates, 2. Beta blockers, 3. Ca channel blockers
Nitroglycerin [generates metHb (Fe3+) binds toxic cyanide = antidote] MOA: nitrate, drug of choice 4 prompt relief of angina due to exertion or emotional stress, significant 1st pass in liver-better sublingual, decreases coronary vasoconstriction to perfuse the heart & relax coronary arteries; ADRs: high dose = reflex tachy
Isosorbide dinitrate MOA: nitrate, decreases coronary vasoconstriction and perfuse the heart by relaxing the coronaries, used for chronic maintenance since not readily metabolized by liver and thus given PO, less potent than nitroglycerin
Nifedipine MOA: Ca channel blocker affects smooth muscle in peripheral vasculature w/ little to no effect on the heart, thus allows for heart to pump vs. less mmHg, relaxes arterioles, best for Prinzmetal angina
Verapamil MOA: Ca channel blocker that affects heart (slows HR) w/ some significant vasculature effect, causes the heart to work less & thus requires less O2, DOC for Prinzmetal angina (cardiac chest pain at rest that occurs in cycles); ADR: reflex tachy
Propranolol MOA: beta-blocker that decreases the work of the heart and O2 demand used for daily antianginal tx and standard in acute unstable angina & MI
Metoprolol MOA: beta-blocker that decreases the work of the heart and O2 demand used for daily antianginal tx and standard in acute unstable angina & MI
Classic Angina -substernal pain, -lasts < 10 mins, -relieved by rest & nitrates
Myocardial Infarction -substernal pain -> spreads to arms or jaw, -lasts > 30 mins, -not relieved by rest or nitrates
Created by: jerrica_08
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