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Pharma > Angina > Flashcards

Angina Flashcards

1
Q

Types of Angina (3)

A

1 atherosclerotic
2 vasospastic
3 unstable

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2
Q

Determinants of cardiac oxygen requirement (2)

A

1 Diastolic factors
2 Systolic factors

both lead to cardiac fiber tension

Inc myocardial O2 req

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3
Q

Diastolic factors (2)

A

Blood volume

Venous tone

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4
Q

Systolic factors (4)

A

Peripheral resistance
Heart rate
Heart force
Ejection time

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5
Q

Goals for angina management(4)

A

Inc O2 delivery
Reduce O2 req
Inc efficiency of O2 utilization
Myocardial revasc

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6
Q

Releases nitric oxide in smooth muscle cells through mitochondrial enzyme aldehyde dehydrogenase 2 ALDH2

A

Nitrates

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7
Q

Given SL, transdermal, IV, oral

High first pass effect

A

Nitroglycerin

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8
Q

Nitrate given orally

A

Isosorbide mononitrate

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9
Q

Nitrate given SL, orally

A

Isosorbide dinitrate

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10
Q

Nitrate inhaled

A

Amyl nitrite

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11
Q

Activates nitrite to nitric oxide by ALDH2/3

NO combines with guanylyl cyclase 
Inc CGMP
PGE prostaglandin production
PGI prostacyclin production
Diminished vascular smooth muscle activation
Vasodilation of arteries and veins
A

Nitrates

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12
Q

Nitrate tolerance attributed to (3)

A

Sulfhydryl group - cysteine
Inc O2 free radicals
Dec calcium generated polypeptide cgrp (vasodilator)

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13
Q

Nitrates relieve angina by

A 
Inc venous compliance
Dec ventricular preload
Relaxation of veins
Dec CO promote diastole inc CBF
Relaxation of bronchi GI
Inc CGMP Dec platelet aggregation
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14
Q

Nitrate SE

A

OH
syncope
headache
Temporal pulsation

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15
Q

Nitrates CI in

A

Inc ICP

IF TOLERATING GIVE CYSTEINE

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16
Q

Nitrates cause

A

compensatory tachycardia, contractility and salt and water retention

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17
Q

Nitrate uses

A

Angina

Cyanide poisoning

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18
Q

Nitrates can promote lethal hypotension if combined with

A

PDE5 inhibitors
Sildenafil
MI

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19
Q

Nitrates cause toxicity of

A

Methemoglobinemia

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20
Q

Alpha 1 recetor affinity with more effect on smooth muscle vs nondihydropiridine bec of K channel

A

Nifedipine

21
Q

Dec transmembrane Ca current leading to
relaxation of vascular, bronchial, GI and uterine smooth muscles
dec in cardiac contractility
dec in SA node/AV node (hr)

A

Ca ch blocker L type

22
Q

Ca ch blockers reduce BP but induce

A

Reflex tachycardia (Nifedipine)

23
Q

Dec heart rate and contractility

Blocks calcium dependent conduction in AV node

A

Non Dihydro Ca ch blocker

24
Q 
Used as prophylaxis for effort and vasospastic angina
HTN
SVT
Migraine 
Preterm labor
Stroke/SAH
Raynaud’s
A

Calcium ch blocker

25
Q

Ca ch blocker SE (4)

A 
AV block nondihydropiridine
MI (short acting Nifed)
Constipation
Bradycardia
Pretibial edema
Flushing Dizziness
26
Q

Dec cardiac workload (BP, HR, contractility)
Dec O2 demand (reduced ischemic time)
Inc heart size
Prolonged ejection

A

Beta blockers

27
Q

Beta blockers inc EDV and ejection time so they are best balanced by

A

nitrates due to inc O2 req

28
Q

Prophylactic tx of exercise induced angina
Dec mortality in px with recent MI
Improves survival with stroke and HTN

A

Beta blockers

29
Q

Beta blocker SE (4)

A

Erectile dysfunction
Hypoglycemia
Worsening claudication
Fatigue, insomnia

Avoid in asthmatics, bradycardics

30
Q

Reduces late sodium current INa that facilitates Ca entry via Na-Ca exchanger dec intracell Ca and prolonging QT interval

A

Ranolazine

31
Q

Dec diastolic tension cardiac contractility and work

A

Ranolazine

32
Q

Ranolazine SE

A

Prolonged QT interval (CAD)

Shortened QT in long QT syndrome

33
Q

Nicotinamide nitrate ester
Dec preload and afterload
Myocardial protective by activating cardiac K ATP ch

A

Nicorandil

34
Q

Inhibits fatty acid oxidation in myocardium
PostMI and angina

Drug class

A

Trimetazidine

PFOX inhibitor

35
Q

How is trimetazidine able to improve metabolic status of ischemic tissue

A

By partial inhibition of enzyme long chain 3 ketoacetyl thiolase LC-3KAT

36
Q

Inhibits xanthine oxidase contributing to oxidative stress and endothelial dysfunction

A

Allopurinol

37
Q

High dose allopurinol prolongs the

A

Exercise time in px with angina

38
Q

Relatively selective If funny Na ch inhibitor

Reduces HR by inhibiting hyperpolarization activated Na ch in SA node but not in afib

A

Ivabradine

39
Q

Reduces angina with efficacy similar to Ca ch blocker and Beta blocker

A

Ivabradine

40
Q

Inhibitor of smooth muscle Rho kinase

A

Fasudil

41
Q

Family of enzyme inhibiting vascular relaxation

A

Rho kinase (ROCK)

42
Q

Reduces coronary spasm in experimental animals

A

Fasudil

43
Q

CAD Medical Therapy (7)

A 
Antiplatelet
Lipid lowering
ACEI
Beta blocker
Nitrate
Ca ch blocker
Anticoagulation
44
Q

Intermittent claudication pain occuring in skeletal ms legs during exercise and disappears with rest

Chronic ischemic ulcers

A

PAD

45
Q

PDE3 Inhibitor, selective antiplatelet and vasodilator for PAD

Inc exercise tolerance in pxs with severe claudication

A

Cilostazol

46
Q

Xanthine derivative reducing viscosity of blood and inc deformability of RBC allowing efficient blood flow in obstructed areas

A

Pentoxyfylline

47
Q

Determinants of vascular tone (4)

A

1 Inc CGMP (dephosphorylation of MLC NO)
2 Dec intracellular Ca (vasodilation, Ca ch blocker Beta blocker)
3 Inc K efflux permeability (opening of K ch prevents depolarization, Minoxil, Diazoxide)
4 Inc CAMP vascular smooth muscle inactivates MLCK(Beta 2 agonist, Fenoldopan D1)

48
Q

Inhibits beta oxidation of FFA

Cytoprotective that normalizes blood flow in low flow ischemia

A

Trimetazidine

Pharma (26 decks)

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