Anti-Anginal Drugs MCQs

Pilocarpine causes marked sweating, salivation and increase in other secretions. The cardiovascular effects are complex. Small doses generally cause fall in BP (muscarinic), but higher doses elicit rise in BP and tachycardia which is probably due to ganglionic stimulation (through ganglionic muscarinic receptors). Applied to the eye, it penetrates cornea and promptly causes miosis, ciliary muscle contraction and fall in intraocular tension lasting 4-8 hours.

This patient has a classic presentation of chronic stable angina, which is characterized by chest pain that occurs with activity and is relieved with rest or sublingual nitroglycerin. Nitrates exert their effect by direct vascular smooth muscle relaxation that results in: Vasodilation of the peripheral veins and arteries, predominantly venodilation Decreased left ventricular wall stress due to reduced preload (decreased left ventricular end-diastolic volume and pressure) Modest reduction in afterload due to systemic arterial vasodilation Mild coronary artery dilation and reduction of coronary vasospasm. This results in decreased myocardial oxygen demand, leading to improved exercise tolerance and relief of angina symptoms. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg. no. 221

Nitroprusside and organic nitrites (eg, amyl nitrite) and nitrates (eg, nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate) contain NO groups that can be released as NO. Arginine is the normal source of endogenous NO. Acetylcho- line, acting on M3 receptors, stimulates the synthesis of NO from arginine. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung

Around-the-clock nitrate administration (in any form) rapidly results in development of tolerance to nitrates. This is why a nitrate-free interval must be provided every day in patients that are using daily long acting nitrates. The mechanism by which this occurs has not been fully demonstrated, but it is theorized that it is due to a decreased vascular sensitivity to nitrates and an increased sensitivity to endogenous vasoconstricting agents. Usually the nitrate-free period is timed to occur during the night when the patient is sleeping and cardiac work is the least. Reference : Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg. no. 214

Nitrates are frequently used for symptomatic relief in patients with chronic stable angina. The anti-ischemic effect of nitrates is mediated by systemic vasodilation (predominantly venodilation) with a decrease in left ventricular end-diastolic volume and wall stress, resulting in decreased myocardial oxygen demand and relief of angina symptoms. The main adverse effects seen with nitrate therapy include headaches, cutaneous flushing, lightheadedness, hypotension, and reflex tachycardia. Nitrates must be avoided in patients with hypertrophic cardiomyopathy (due to increased outflow tract obstruction), right ventricular infarction (due to reduction in preload, impairing cardiac output), and those on phosphodiesterase inhibitors (synergism increases the risk of severe hypotension). Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg. no. 217

Filgrastim (G-CSF) stimulates the production and function of neutrophils, important cellular mediators of the innate immune system that serve as the first line of defense against infection. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Pg no. 834