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PHARMACOLOGY > ANGINA > Flashcards

ANGINA Flashcards

1
Q

t or f

ischemia is a symptom of angina

A

t

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2
Q

Regional flow distribution is improved by _________,____,_______

A

nitrates, ccb, b blockers

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3
Q

coronary blood flow is increased by____,____

A

nitrates, ccb

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4
Q

Heart rate and cardiac contractility is decreased by

A

b-blocker, CCB

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5
Q

Drugs that reduce cardiac size (the preload and

afterload), rate, or force reduce cardiac oxygen demand

A

Vasodilators, Beta blockers, Calcium channel blockers

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6
Q

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

A

late sodium current

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7
Q

Drugs that shift myocardial metabolism towards greater

use of glucose

A

fatty acid oxidation inhibitors

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8
Q

determines left ventricular systolic wall stress

A

Arteriolar tone

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9
Q

Determine right ventricular diastolic wall stress

A

Venous tones

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10
Q

Calcium- calmodulin complex

A

Prevent mlck

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11
Q

Sildenafil will inhibit ____

A

Pde

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12
Q

Most prevalent form of angina pectoris

A

stable angina

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13
Q

with myocardial 02 demand

A

stable

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14
Q

without increase in myocardial O2 demand, with coronary thrombosis

A

unstable or ACS

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15
Q

local vasospasm

A

variant/prinzmetal

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16
Q

Tx for variant angina

A

Nitrovasodilators and ccb

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17
Q

Drug-induced causes of variant angina

A

Cocaine, amphetamines,sumatriptan, antimigraine

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18
Q

2nd line of defense (unstable angina)

A

nitrates

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19
Q

Coronary micro-vascular dysfunction

A

No obstruction

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20
Q

activates the soluble isoform of guanylyl cyclase

A

Nitric oxide (organic nitrates)

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21
Q

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

A

low doses

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22
Q

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.

A

low to medium

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23
Q

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

A

higher doses (nitrates)

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24
Q

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”)

A

Non-selective vasodilator ( adenosine or dipyridamole)

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25
Q

X therapeutically

✅ stress test

A

Dipyridamole

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26
Q

Tolerance to nitrates

A

Loss of response, decrease angina threshold

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27
Q

Organic nitrate dependence, workers exposed to GTN

A

Monday disease

28
Q

Hours to return the nitrate efficacy, to prevent tolerance

A

8 to 12 hours

29
Q

Px with exertional dyspnea

A

Most convenient: at night

30
Q

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

A

Nitrates at night

31
Q

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

A

Sildenafil

32
Q

Nitrate response

A

Veins > arteries

33
Q

Nitrates indirect effect

A

Dec arterial pressure, tachycardia, inc contractility

34
Q

Verapamil acts on

A

L-type

35
Q

T or F

CC B do not affect Cardiac preload significantly when given at normal doses

A

t

36
Q

Reynauds phenomenon

A

Felodipine, Nifedipine, Diltiazem, Verapamil

37
Q

▪ 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

A

Nifedipine

38
Q

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

A

verapamil

39
Q

Px with neurological deficits secondary to cerebral vasospasm

A

nimodipine

40
Q

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

A

VERAPAMIL

41
Q

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

A

IV VERAPAMIL

42
Q

Ccb toxicity

A

peripheral edema (inc hydrostatic pressure

43
Q

effects of CCBs in cardiac muscle

A

dec contractility and heart rate

44
Q 
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.
A

bblockers

45
Q

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,

A

REVERSE STEAL OR

ROBIN HOOD PHENOMENON

46
Q

for steal phenomenon

A

nitrates

47
Q

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

A

bblockers

48
Q

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

A

BETA 1 SELECTIVE (ATENOLOL,

BISOPROLOL, METOPROLOL)

49
Q

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

A

beta blockers

50
Q

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

A

nitrates

51
Q

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

A

Ranolazine

52
Q

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

A

ranolazine

53
Q

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

A

ranolazine

54
Q

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

A

Ivabradine

55
Q

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

A

Ivabradine

56
Q

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

A

nicorandil

57
Q

side effects of nicorandil

A

Large painful buccal apthosis and risk of GI

ulceration and perforations

58
Q

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

A

trimetazidine

59
Q

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

A

trimetazidine

60
Q

▪ 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

A

trimetazidine

61
Q

Abandoned due to reports of hepatotoxicity and

▪ Shift myocardial metabolism from fatty acid oxidation to more efficient glucose oxidation

A

Perhexiline

62
Q

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

A

Fasudil

63
Q

medications for microvascular angina

A 
o  BB
o  CCB
o Nicorandil 
o  Ranolazine 
o  Ivabradine 
o  Trimetazidine
64
Q

medications for vasoplastic angina

A

CCB, long acting nitrates, nicorandil

65
Q

At low doses 75 to 150 mg/day reduces incidence

of clinical events.

A

aspirin

66
Q

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

A

clipidogrel

67
Q

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.

A

aceis/ arbs

PHARMACOLOGY (13 decks)

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