Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > 11) Anti-Anginal Drugs > Flashcards

11) Anti-Anginal Drugs Flashcards

1
Q

Evolution of a plaque

A
  • Normal artery
  • Fatty streak
  • Mature plaque
  • Ruptured plaque with thrombus formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Effects of myocardial injury

A
  • ST wave elevation

- Occurs with or without loss of R wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Effects of myocardial ischemia

A
  • ST wave depression
  • Occurs with or without loss of T wave inversion
  • Due to altered repoarization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Effects of myocardial infarction

A
  • Deep Q wave

- Due to absence of depolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 zones of myocardial damage (least to most damaging)

A
  • Zone of ischemia
  • Zone of injury
  • Zone of infarction/necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal response of myocardium to increased needs / demands / requirements of oxygen

A
  • Coronary artery (CA) dilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In diseased CA (atherosclerosis &/ plaque), the flow/ supply to myocardium

A
  • Is less so the myocardium “starves” for oxygen (ischemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardinal sign of coronary artery disease (CAD)

A
  • Chest pain/angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Anti-anginal agents (classes)

A
  • Nitrates
  • Calcium channel blockers
  • Beta blockers
  • Metabolism modifiers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anti-anginal nitrates (brands/generics)

A
  • Nitrostat (nitroglycerin)
  • Ismo (isosorbide mononitrate)
  • Bidil (isosorbide dinitrate and hydralazine)
  • Isordil (isosorbide dinitrate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anti-anginal calcium channel blockers (brands/generics)

A
  • Nymalize (nimodipine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anti-anginal beta blockers (brands/generics)

A
  • Metoprolol
  • …OLOL
  • Anything ending in -olol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anti-anginal metabolism modifiers (brands/generics)

A
  • Ranexa (ranolazine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nitrates (all anti-anginal mentioned) mechanism of action

A
  • Nitroglycerin forms the free radical nitric oxide (NO)
  • NO activates cGMP in smooth muscle
  • Results in vasodilatation and reduction in preload and afterload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nitroglycerin duration of action

A
  • 10 to 20 min (sublingual for relief of acute attacks)

- 8 to 10 h (transdermal for prophylaxis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nitroglycerin (glyceryl trinitrate) is rapidly de-nitrated in the liver and in smooth muscle to…

A
  • First to the 2 dinitrates (glyceryl dinitrate)…retain a significant vasodilating effect
  • More slowly to the mononitrates…much less active
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Because of the high enzyme activity in the liver, the first-pass effect for nitroglycerin is

A
  • About 90%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Short-acting nitrates

A
  • Nitroglycerin sublingual (SL): Rapid onset (1 min), short duration (15 min)
  • Isosorbide dinitrate SL: Rapid onset (1 min), duration (20–30 min)
19
Q

Intermediate-acting nitrates

A
  • NTG oral, isosorbide dinitrate and mononitrate, oral
  • Slow onset
  • Duration: 2-4 h
20
Q

Long-acting nitrates

A
  • Transdermal nitroglycerin
  • Slow onset
  • Duration: 10 h
21
Q

Ultra short-acting nitrate

A
  • Amyl nitrite Volatile liquid
  • Vapors are inhaled
  • Onset seconds
  • Duration: 1-5 min
22
Q

Nitrates adverse reactions (ADRs)

A
  • Only the smallest dose required for effective relief of the acute anginal attack should be used
  • Excessive use may lead to the development of tolerance
  • Severe hypotension, including tachycardia (from the baroreceptor reflex), orthostatic hypotension, headache, and blurring of vision
23
Q

Nitrates drug interactions

A
  • Administration of nitroglycerin is contraindicated in patients who are using PDE-5 inhibitors (e.g. sildenafil (Viagra®), tadalafil, vardenafil and avanafil)
  • These compounds have been shown to potentiate the hypotensive effects of organic nitrates
24
Q

Calcium channel blockers anti-anginal mechanism of action

A
  • Block voltage-gated L-type calcium channels (cardiac and smooth muscle)
  • Reduce intracellular calcium concentration and muscle contractility
25
Q

Dihydropyridine calcium channel blockers

A
  • Amoldipine
  • Felodipine
  • Isradipine
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Nisoldipine
26
Q

Amoldipine

A
  • Brand = Norvasc
  • Onset = 30min
  • DOA = 24h
27
Q

Felodipine

A
  • Brand = Plendil
  • Onset = 2-5h
  • DOA = 24h
28
Q

Isradipine

A
  • Brand = Dynacirc
  • Onset = 2h
  • DOA = > 12h
29
Q

Nicardipine

A
  • Brand = Cardene
  • Onset = 30min
  • DOA = < 8h
30
Q

Nifedipine

A
  • Brand = Procardia
  • Onset = 20min
  • DOA = ?
31
Q

Nimodipine

A
  • Brand = Nimtop
  • Onset = ?
  • DOA = 6h
32
Q

Nisoldipine

A
  • Brand = Sular
  • Onset = ?
  • DOA = 12h
33
Q

Phenylaklyamine calcium channel blockers

A
  • Verapimil
34
Q

Verapimil

A
  • Brand = Calan, Verelan
  • Onset = 30min
  • DOA = 8h
35
Q

Benzothiazepine calcium channel blockers

A
  • Diltiazem
36
Q

Diltiazem

A
  • Brand = Cardizem
  • Onset = 30-60min
  • DOA = 4h
37
Q

All calcium channel blockers are

A
  • CYP450 substrates
38
Q

CCB metabolism and excretion

A
  • Hepatic metabolism

- Excreted in urine

39
Q

CCBs with extensive first pass metabolism

A
  • Felodipine
  • Isradipine
  • Nimodipine
  • Nisoldipine
  • Verapamil
  • Diltiazem
40
Q

Beneficial beta-blocking drug actions

A
  • Decreased heart rate, cardiac force, blood pressure

- Reduce cardiac work, and oxygen demand

41
Q

Detrimental beta-blocking drug actions

A
  • Increased heart size

- Longer ejection period

42
Q

Beta blockers are used only for prophylactic therapy of

A
  • Angina

- No value in an acute attack

43
Q

Ranolazine (Ranexa) action

A
  • Relatively new drug
  • Reduces a late, prolonged sodium current
    (late INa) in myocardial cells
  • Decrease in intracellular Na causes increased Ca expulsion (via Na/Ca transporter)
  • Reduces cardia force and work
  • May also alter cardiac metabolism
44
Q

Ranolazine (Ranexa) ADRs

A
  • QT- prolongation potentially (it affects Na+ currents)
  • Renal failure
  • Most commonly mild ADR
    profile: N/V/D and
    constipation
  • Hypotension
  • Contraindicated with concurrent strong CYP3A4 inhibitors and inducers because it is a substrate of CYP3A

Pharmacology (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions