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3 PHARM SELF > 41Coronary Heart > Flashcards

41Coronary Heart Flashcards

1
Q

What are the 4 general things we do to decrease O2 demand and increase O2 supply?

A

decrease work of heart
inhibit platelet aggregation/thrombus
prevent or inhibit vasospasm
mechanical interventions

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2
Q

What are the 4 main antianginal agents?

A

nitrovasodilators
beta adrenergic blockers
calcium channel blockers
ACEI/ARB

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3
Q

What happens to heart rate contractility with nitrovasodilators? Wall stress and MVO2? after load? preload?

A
  1. reflex increase in contractility
  2. decrease wall stress and MVO2
  3. decrease preload
    4 decrease afterload
    [this all reduces O2 demand]
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4
Q

What nitovasodilator goes through the mitochondria to become NO? smooth ER? Which one does not need metabolized?

A
  1. GTN
  2. ISDM,ISMN
    3nitroprusside
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5
Q

What are the 3 main mechanisms of actions for nitrovasodilators?

A

Relaxes large arteries
Relaxes all veins
inhibit platelet aggregation

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6
Q

What happens if you don’t take off your transdermal nitrate patch at night?

A

build tolerance quickly

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7
Q

Does isosorbide denigrate or isosorbide mononitrate have the shorter half life?

A

ISDN-administered 3-4 times daily

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8
Q

What is the order of headache intensity for the nitrates?

A

GTN>ISDN>ISMN [it is a sign that they are working!!]

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9
Q

When are nitrates contraindicated?

A

erectile dysfunction pills- PDE5

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10
Q

What does NO and nitrates enhance?

A

sGC which takes GTP to cGMP

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11
Q

Which PDE5 inhibitor has the longest half life? shortest? longest onset? shortest onset?

A
  1. tadalafil 2. vardenafil/sildenafil

3. sildenafil 4. avanafil

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12
Q

What is the mechanism of action of beta adrenergic receptor agonists? beta 1 blocker effects? beta 2 blocker effects

A
  1. inhibit sympathetics
  2. decrease HR and contractility, decrease renin
    3 potentiate alpha adrenergic effects- vasoconstrict
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13
Q

beta 2 selective antagonists have receptors where?

A

blood vessels, bronchioles and pancreas

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14
Q

Can beta blockers cause impotence?

A

yes

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15
Q

Do beta blockers cause hyperglycemia and hyperlipidemia?

A

hypoglycemia and hyperlipidemia

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16
Q

Do beta blockers prolong survival in patients with compensated HF? what may worsen HF?

A
  1. Yes by decreasing MVO2

2. negative ionotropic effects

17
Q

What is the rebound phenomenon with beta receptor antagonists?

A

worsening of MI with abrupt discontinuation of use due to up regulation of beta adrenergic receptors

18
Q

What do calcium channel blockers do to vasculature? cardiac?

A
  1. relax arteries- minimal vein effect

2. decreases contractility of myocytes

19
Q

How do calcium channel blockers reduce O2 demand?

A

decrease arterial pressure
decrease contractility
decrease heart rate

20
Q

How do calcium channel blockers increase O2 supply

A

dilate epicardial arteries and stenoses

prevent vasospasm

21
Q

Is nifedipine good in acute MI?

A

No, can worsen

22
Q

Are calcium channel blockers better for secondary MI prevention than Beta blockers?

A

No

23
Q

should we use valium channel blockers in heart failure?

A

no–due to negative inotropic effect

24
Q

Do inhibitors of RAS prevent secondary MI?

A

Yes

25
Q

When should we avoid use of ranolazine?

A

in patients with prolonged QT intervals or hepatic involvement

26
Q

Does ranolazine have a chronotropic or isotropic effect? does it effect heart rate and blood pressure? what does it improve?

A

No, no, exercise tolerance

27
Q

What do we treat an acute angina attack with?

A

sublingual nitrates and aspirin

28
Q

What are the 2 main steps we try to do in order to treat chronic unstable CHD, Angina?

A

Reduce myocardial oxygen demand

stabilize atherosclerotic plaque

29
Q

Which platelet inhibitor has the fewest drug interactions?

A

plasugrel

30
Q

What do we treat acute unstable CHD MI with?

A

MONA

morphine, oxygen, nitroglycerin, aspirin

31
Q

What is microvascular angina (syndrome X?

A

angina like discomfort with exercise, ST-segment depression or other signs of ischemia, normal coronary arteries, microvascular dysfunction

Treat with, beta blockers, calcium blockers, ACEI and statins

3 PHARM SELF (13 decks)

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