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Pharm II > angina > Flashcards

angina Flashcards

1
Q

how do you treat variant/angiospastic/prinztmetals angina

A

nitrates, CCB

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2
Q

O2 demand depends on —— which is determine by —–?

A 
cardiac workload
which is determined by:
1. HR
2. contractility
3. Ventricular wall tension
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3
Q

What does wall tension represent and how is it increased

A

wall tension = force developed during contraction

*increase wall tension by increasing pressure and/or increasing volume

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4
Q

any increase in HR or contractility will cause what

A

increase the need for O2

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5
Q

O2 supply depends on

A

myocardial delivery and extraction

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6
Q

heart normally extracts 75% of O2 in blood so how can you increase O2 available to tissues

A

only way is to increase O2 delivery through coronary blood flow

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7
Q

Coronary blood flow is directly proportional to

A

perfusion pressure

duration of diastole

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8
Q

Coronary flow may be decreased by

A
  1. shortening diastole (due to ^HR) (this decreases filling time)
  2. Increased vendtricular end diastolic pressure
  3. reduced diastolic arterial pressure
    * prevents pressure gradiant that is conducive to blood flow
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9
Q

MOA of nitrates/nitrite

A

vasodilation via NO that stimulates cGMP (dephos Myosin LC) = relax

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10
Q

describe the vasodilation that occurs with nitrates/nitrites

A

UNEVEN: veins more dilated = increase venous capacitance = decreased preload

*arterioles dilated less but still decrease afterload

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11
Q

Nitrates are DOC for

A

acute angina attack

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12
Q

What makes nitrates good/bad

A

good: decrease cardiac workload bc decrease preload and afterload

BAD: increase cardiac workload: bc the dec BP stimulates baroreflex to increase HR an contractility thus decreasing diastolic perfusion time

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13
Q

what makes for anginal relief

A

Predominant: decrease myocardial O2 requirement
Secondary: redistribution of coronary blood flor to ischemic areas
*also relax SM in bronchi, GI and GU

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14
Q

pharmacokinetics of oral organic nitrates

A

rapid hepatic metab with high first pass

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15
Q

what are the fastest acting nitrites

A

inhaled: amyl nitrite
IV: nitroprusside

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16
Q

benefits to SL nitrite

A

avoids hepatic damage!
rapid absorption
immediate anginal relief (1-3 min onset, lasts 10-30min)

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17
Q

amyl nitrite form

A

volatile liquids, inhaled

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18
Q

Isosorbide dinitrate form

A

solid, SL or oral tab

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19
Q

Adverse effects of nitrates

A

acute toxicity, pronounced vasodilation causes:
orthostatic hypotension, tachycardia, HA
*not suitable for long term

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20
Q

what is mondays disease

A

explosive manufacturers w/ chronic exposure
friday sx disappear bc tolerance
monday: HA/dizzy

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21
Q

How do CCB work

A

relax all SM dependent on Ca

*differences in tissue selectivity can result in opposite effects on HR (dipines increase HR, verapamil decreases HR)

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22
Q

when is slow release nifedipine indicated

A

ONLY in HTN

*may provoke angina (bc increase HR)

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23
Q

what type of tx are CCB good for (re angina)

A

chronic angina, not for immediate angina relief

24
Q

Nifedipine benefits

A

coronary vasodilation increases myocardial O2 supply, decreases afterload

25
Q

Nifedipine harmful effect

A

enhanced development of MI

*rapid hypotension –> baroreflex –> increase cardiac workload

26
Q

Verapamil/diltiazem benefit

A

decreased cardiac workload: decrease myocardial contractility, bradycardia (bc dec SA and AV node)

27
Q

harmful effect of Verapamil/diltiazem

A

potential to cause serious cardiac depression –> cardiac arrest, AV block, CHF

28
Q

BB major effects are..

A

both cardiac and vascular

29
Q

3 organs BB has CV effect on

A

heart: decrease CO
Kidney: decrease renin
CNS: decrease SNS

30
Q

how do BB cause anginal relief

A

decrease SNS = dec cardiac activity and dec vasoconstriciton = hypotension, dec HR = decreased cardiac workload = decreased myocardial O2 demand
*also, dec HR increases myocardial perfusion time

31
Q

can BB produce coronary vasodilation?

A

NO NO NO… BB do not cause direct vasodilation thus are NOT indicated for variant angina

32
Q

what type of angina should we use BB for

A

CLASSICAL - not variant bc BB do not cause direct vasodilation

33
Q

adverse effects of BB include

A

bronchoconstriciton (bad for asthma)
^ TAG: bad for hyperlipidemics
^ Glu intolerance: bad for DM
CNS SE: fatigue/depression/sleep disturbances
*potentially harmful if used in variant angina bc slows HR, prolongs ejection time = increase LV end diastolic volume = increase myocardial O2 requirement

34
Q

MOA of Fanolazine and indication

A 
PFox inhibitor (decrease O2 consumption in ischemic tissue, decrease contractility)
*use only when others don't work
35
Q

why are BB potentially harmful in variant angina

A

*potentially harmful if used in variant angina bc slows HR, prolongs ejection time = increase LV end diastolic volume = increase myocardial O2 requirement

36
Q

effective tx of angina will..

A

increase exercise tolerance

decrease freq and duration of myocardial ischemia

37
Q

tx for variant

A

nitrates and CCB
*but slow release nifedipine may worsen angina, better for nitrate + cardio CCB ie verapamil

*BB will not cause vasodilation of spastic coronary vessels

38
Q

Most effect drug combo for classic angina

A

BB and vasodilator

39
Q

how can you minimize the harmful effects of CCB or BB

A

by combing with nitrates and vice versa

40
Q

how can you minimize reflex tachy

A

combine nitrates with CCB or BB

41
Q

preferred for asthma angina pt

A

CCB (verapamil) and nitrate

least: BB

42
Q

DM angina pt tx

A

CCB (verapamil) and nitrate

least: BB

43
Q

CHF angina pt tx

A

nitrate

least: BB, CCB (verapamil, diltiazem)

44
Q

HTN angina pt tx

A

BB, CCB

least: nitrate

45
Q

PUD angina pt tx

A

BB, nitrate

least: CCB

46
Q

Sildenafil MOA and use

A

selective inhibitor of cGMP PDE5

*intended for angina but found to be better for ED

47
Q

indication for sildenafil

A

ED, pulm HTN

48
Q

PK of sildenafil

A

oral, rapid absorption, 40% bioavailable

Max concentration: 30-120 min, t1/2 4 hr

49
Q

how is sildenafil metab

A

CYP3A4 major

CYP2C9 minor

50
Q

Adverse effects of Sildenafil

A

mild/mod: HA, flushing, dyspepsia, nasal congestion, UTI, blue color tinge to vision/ blurred vision

51
Q

When should you not rx sildenafil

A

pregnant/lactating, pt currently on nitrates, pt on alpha blockers (double hypotension effect)

52
Q

other contraindication for sildenafil

A

inhibitors of CYP3A4 and 2CP: increase sildenafil
*ketoconazole, erythromycin, quinidine, Cimetidine/omeprazole

*note omeprazole also increases toxicity of quinidine and warfarin and clopidogrel

53
Q

other PDE5 inhibitors and MOA

A

Vardenafil and Tadalafil

*more selective for PDE5 than PDE6, less visual blue tinge

54
Q

Vardenafil benefits

A

faster onset than sildenafil or tadalafil

55
Q

Tadalafil benefits

A

longer duration (24-36 hours) = spontaneity

Pharm II (12 decks)

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