ANGINA

Question 1

t or f

ischemia is a symptom of angina

Answer 1

t

Question 2

Regional flow distribution is improved by _________,____,_______

Answer 2

nitrates, ccb, b blockers

Question 3

coronary blood flow is increased by____,____

Answer 3

nitrates, ccb

Question 4

Heart rate and cardiac contractility is decreased by

Answer 4

b-blocker, CCB

Question 5

Drugs that reduce cardiac size (the preload and

afterload), rate, or force reduce cardiac oxygen demand

Answer 5

Vasodilators, Beta blockers, Calcium channel blockers

Question 6

Drugs that block________ can indirectly reduce
calcium influx and consequently reduce cardiac
contractile force

Answer 6

late sodium current

Question 7

Drugs that shift myocardial metabolism towards greater

use of glucose

Answer 7

fatty acid oxidation inhibitors

Question 8

determines left ventricular systolic wall stress

Answer 8

Arteriolar tone

Question 9

Determine right ventricular diastolic wall stress

Answer 9

Venous tones

Question 10

Calcium- calmodulin complex

Answer 10

Prevent mlck

Question 11

Sildenafil will inhibit ____

Answer 11

Pde

Question 12

Most prevalent form of angina pectoris

Answer 12

stable angina

Question 13

with myocardial 02 demand

Answer 13

stable

Question 14

without increase in myocardial O2 demand, with coronary thrombosis

Answer 14

unstable or ACS

Question 15

local vasospasm

Answer 15

variant/prinzmetal

Question 16

Tx for variant angina

Answer 16

Nitrovasodilators and ccb

Question 17

Drug-induced causes of variant angina

Answer 17

Cocaine, amphetamines,sumatriptan, antimigraine

Question 18

2nd line of defense (unstable angina)

Answer 18

nitrates

Question 19

Coronary micro-vascular dysfunction

Answer 19

No obstruction

Question 20

activates the soluble isoform of guanylyl cyclase

Answer 20

Nitric oxide (organic nitrates)

Question 21

Preferentially dilates veins and conductance
arteries and leave the tone of the small to
medium arterioles (that regulate resistance)
unaffected

Answer 21

low doses

Question 22

Preferential venodilation decreases venous
return, leading to a fall in left and right ventricular
chamber size and end-diastolic pressures,
reduced wall stress, and thereby reduced cardiac
O2 demand
▪ Heart rate remains unchanged or may increase
slightly in response to a decrease in blood
pressure
▪ Pulmonary vascular resistance and cardiac
output are slightly reduced.
▪ They may still produce arteriolar dilation in the
face and neck, resulting in facial flush or dilation
of the meningeal arterial vessels, causing
headache.

Answer 22

low to medium

Question 23

Increase venous pooling and decrease arteriolar
resistance, thereby decreasing systolic and
diastolic blood pressure causing pallor,
weakness, dizziness, and activation of
compensatory sympathetic reflexes
▪ It can compromise coronary flow and sympathetic
increase in myocardial O2 demand leading to
ischemia
▪ May produce Bezold-Jarisch reflex with
sublingual administration producing bradycardia
and hypotension

Answer 23

higher doses (nitrates)

Question 24

worsen the perfusion of ischemic areas by dilating the relatively constricted arterioles of the healthy myocardium, leading to redistribution of decrease angina threshold in the interval
blood flow away from the ischemic myocardium
(“Steal Phenomenon”)

Answer 24

Non-selective vasodilator ( adenosine or dipyridamole)

Question 25

X therapeutically | ✅ stress test

Answer 25

Dipyridamole

Question 26

Tolerance to nitrates

Answer 26

Loss of response, decrease angina threshold

Question 27

Organic nitrate dependence, workers exposed to GTN

Answer 27

Monday disease

Question 28

Hours to return the nitrate efficacy, to prevent tolerance

Answer 28

8 to 12 hours

Question 29

Px with exertional dyspnea

Answer 29

Most convenient: at night

Question 30

Px with anginal pattern assoc.by increase in left ventricularfilling pressures

Answer 30

Nitrates at night

Question 31

also approved in patients with pulmonary hypertension by decreasing pulmonary vascular resistance and enhanced exercise capacity.

Answer 31

Sildenafil

Question 32

Nitrate response

Answer 32

Veins > arteries

Question 33

Nitrates indirect effect

Answer 33

Dec arterial pressure, tachycardia, inc contractility

Question 34

Verapamil acts on

Answer 34

L-type

Question 35

T or F | CC B do not affect Cardiac preload significantly when given at normal doses

Answer 35

t

Question 36

Reynauds phenomenon

Answer 36

Felodipine, Nifedipine, Diltiazem, Verapamil

Question 37

▪ Reduces slow inward current in a dose dependent manner, it does not affect the rate of recovery of the slow Ca+ channel ▪ It has clear negative chronotropic effects in isolated preparation (demand is decreasing) ▪ Does not directly affect pacemaking or conduction of AV node rather it stimulates the heart indirectly by eliciting reflex sympathetic activation in response to a lowering of blood pressure

Answer 37

Nifedipine

Question 38

Not only reduces the magnitude of the Ca+ entry current through the slow channel, but also decreases the rate of recovery of the channel. stimulation prevails ▪ Depress the rate of the sinus node pacemaker and slow AV conduction at clinically used doses; the latter effect is the basis for their use in the treatment of supraventricular tachyarrhythmias ▪ It improves left ventricular outflow obstruction and symptoms in patients with Hypertrophic cardiomyopathy because there is negative inotropic effect. ▪ Use prophylaxis for migraine headaches and considered as second choice

Answer 38

verapamil

Question 39

Px with neurological deficits secondary to cerebral vasospasm

Answer 39

nimodipine

Question 40

In patients without heart failure -_________ o reduces peripheral vascular resistance and blood pressure with minimal changes in heart rate. o Ventricular performance in not impaired and actually may improve, especially if ischemia limits performance

Answer 40

VERAPAMIL

Question 41

In patients with heart failure -_______ o can cause marked decrease in contractility and left ventricular function. it is primarily as with all Ca+ channel blocker to a reduction in myocardial O2 demand. amlodipine and felodipine did not worsen the prognosis of patients with heart failure and can therefore administered if indicated for other reasons

Answer 41

IV VERAPAMIL

Question 42

Ccb toxicity

Answer 42

peripheral edema (inc hydrostatic pressure

Question 43

effects of CCBs in cardiac muscle

Answer 43

dec contractility and heart rate

Question 44

``` Only drug class that is effective in reducing the severity and frequency of attacks of exertion or effort angina and in improving survival in patients who have had a myocardial infarction. ```

Answer 44

bblockers

Question 45

Increased blood flow towards ischemic regions by increasing coronary collateral resistance and preventing blood from being shunted away from the ischemic myocardium during maximal coronary vasodilation,

Answer 45

REVERSE STEAL OR | ROBIN HOOD PHENOMENON

Question 46

for steal phenomenon

Answer 46

nitrates

Question 47

1st line tx for CAD, not useful for vasospastic angina

Answer 47

bblockers

Question 48

Standard compounds for the treatment of angina are beta 1 selective and without intrinsic sympathomimetic activity

Answer 48

BETA 1 SELECTIVE (ATENOLOL, | BISOPROLOL, METOPROLOL)

Question 49

may be va,uable in treating silent ischemia, total ischemic time is reduced with long term use of this

Answer 49

beta blockers

Question 50

balance effect of increase in end diastolic volume and inc ejection time in bblockers

Answer 50

nitrates

Question 51

inhibits the late lNa, → and there an interplay in the NCX, → decreasing the calcium overload → Reducing and relaxing diastolic wall stress → Reduces myocardial ischemia

Answer 51

Ranolazine

Question 52

Reduces cardiac fatty acid oxidation and stimulates glucose metabolism without inhibiting carnitine palmityl transferase

Answer 52

ranolazine

Question 53

Prolongs the QT interval but shortens in patients with long QT syndrome, LQRT3

Answer 53

ranolazine

Question 54

Treating stable angina and heart failure in patients with whom beta blockers are not tolerated or are insufficiently effective in reducing the heart rate and FDA approved only for the treatment of heart failure

Answer 54

Ivabradine

Question 55

Selective blocker of hyperpolarization- activated HCN ion channels involved in the generation of automaticity in the SA node

Answer 55

Ivabradine

Question 56

tx of stable angina, with nitrate-like effects and acts as an agonist at ATP sensitive potassium channels

Answer 56

nicorandil

Question 57

side effects of nicorandil

Answer 57

Large painful buccal apthosis and risk of GI | ulceration and perforations

Question 58

Inhibition of long chain 3 ketoacyl coenzyme A thiolase, the final enzyme in the FFA beta oxidation pathway

Answer 58

trimetazidine

Question 59

Reduce angina and increase exercise tolerance particularly in patients with diabetes and heart failure

Answer 59

trimetazidine

Question 60

▪ Associated with thrombocytopenia, agranulocytosis, and liver dysfunction ▪ Increase risk of movement disorders such as Parkinson’s disease, particularly in older patients with decreased renal function

Answer 60

trimetazidine

Question 61

Abandoned due to reports of hepatotoxicity and | ▪ Shift myocardial metabolism from fatty acid oxidation to more efficient glucose oxidation

Answer 61

Perhexiline

Question 62

inhibitor of smooth muscle Rho Kinase and reduces coronary vasospasm in experimental animals

Answer 62

Fasudil

Question 63

medications for microvascular angina

Answer 63

``` o BB o CCB o Nicorandil o Ranolazine o Ivabradine o Trimetazidine ```

Question 64

medications for vasoplastic angina

Answer 64

CCB, long acting nitrates, nicorandil

Question 65

At low doses 75 to 150 mg/day reduces incidence | of clinical events.

Answer 65

aspirin

Question 66

was slightly superior to aspirin in patients with chronic atherosclerotic vascular disease and had a favorable safety profile

Answer 66

clipidogrel

Question 67

Unclear benefits in patients with CAD when given routinely in addition to aspirin, statins, and beta blocker but they are recommended for subgroups with CAD with reduced left ventricular systolic function, hypertension, diabetes or chronic kidney disease. If you have a patient with HF or angina you have to give this.

Answer 67

aceis/ arbs