Angina

Question 1

coronary artery partly blocked
reduced blood flow through narrowed arteries cannot meet increased oxygen demand
EKG: ST depression

Answer 1

Classic Angina

Question 2

results from spasm of one of the largest arteries of heart
EKG: ST elevation
coronary angiography normal - no narrowing

Answer 2

Variant angina/ Prinzmetal angina

Question 3

occurs when significant occlusion of coronary artery 
angina symptoms occur at rest
might signal MI
medical emergency 
EKG: ST depression

Answer 3

Acute coronary syndrome/ Unstable Angina

Question 4

chest pain 5-10 min
nitrate relieves pain
plasma enzymes troponin, CPK-MB normal

Answer 4

Angina

Question 5

chest pain > 20 min
nitrate does not relieve pain
Increase plasma enzymes troponin, CPK-MB
EKG: Q wave, ST upwardly convex elevation, T inverse

Answer 5

MI

Question 6

Chest pain continues for days 
dull 
sit up & lean forward to relieve pain 
fever
friction rub 
EKG: ST concave elevating 
WBC increases

Answer 6

Pericarditis (bacteria, virus)

Question 7

release NO - activates guanylyl cyclase to form cGMP - dephosphorylates MLC leading to smooth muscle relaxation
reduce cardiac preload at lower dose
dilate artery at high doses

Answer 7

nitrates

Question 8

nitrate given sublingually, IV, oral, ointment, slow release patch

Answer 8

Nitroglycerin

Question 9

nitrate given sublingually & orally for chronic maintenance

Answer 9

isosorbide dinitrate

Question 10

nitrate given orally for chronic maintenance

Answer 10

isosorbide mononitrate

Question 11

ADR: severe headache, tolerance (tachyphylaxis) [drug holiday - Monday dz: re-sensitize], postural hypotension, methemoglobinemia

Answer 11

nitrates

Question 12

Contraindications: w/in 24 hours of nitrates use can not use __________- severe hypotension, may lead to MI

Answer 12

Sildenafil

Question 13

oppose action of adrenaline in heart, reduce work load of heart, helps prevent future angina, used in prophylaxis only
contraindications: prinzmetal angina

Answer 13

Beta blockers

Question 14

both nitrate & K ch opener effects
stabilizes excitable cells near resting membrane potential
causes relaxation of smooth muscle (vasodilation)
decreases preload & afterload
dilates coronary artery

Answer 14

Nicorandil

Question 15

treats chronic angina (limits size of ischemia & infarct area)
1. inhibits Na+ current and more Ca2+ excreted - less contraction
2. at high doses - pFOX inhibitor, shifts from pFOX to glucose oxidation
SE: Q-T prolongation

Answer 15

Ranolazine

Question 16

phosphodiesterase type 2 inhibitor
decreases cAMP degradation
inhibits platelet & vasodilator
treats: leriche syndrome (leg intermittent claudication)

Answer 16

Cilostazol

other drugs: aspirin (prevent TXA2 production)
Clopidogrel
Abciximab (Gb2b3a inhibitor)

Question 17

non selective CCB
causes long QT syndrome
blocks Na+ ch activity

Answer 17

Bepridil

Question 18

CCB that prevent vasospasm in subarachnoid hemorrhage to prevent ischemic stroke complication

Answer 18

Nimodipine

Nicardipine

Question 19

slows cardiac conduction
decreases HR & O2 demand
blocks P glycoprotein drug efflux transporter
reverses chloroquine resistance in malaria treatment
never combine with beta blockers

Answer 19

verapamil

Question 20

mainly artery dilator
useful for treatment of variant angina
given with beta blocker to prevent reflex tachycardia

Answer 20

Nifedipine

Question 21

slows cardiac conduction
decreases HR & O2 demand
specific coronary vasodilation effect relieving coronary vasospasm
useful in treatment for variant angina

Answer 21

Diltiazem

Question 22

major action of nitrates on capacitance vessels (veins)

Answer 22

venodilation -> decrease preload (venous return) -> decrease cardiac work -> decrease oxygen requirement