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CRAAB 1 Week 3, 4, 5 > Angina/Anti-Anginal Drugs > Flashcards

Angina/Anti-Anginal Drugs Flashcards

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1
Q

What is angina?

A

Chest pain caused by an accumulation of metabolites as a result of myocardial ischemia

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2
Q

Angina is a _______, not a ______.

A

Symptom; disease

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3
Q

Most common cause of angina?

A

Atheromatous obstruction of large coronary vessels.

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4
Q

Primary cause of angina?

A
  • Imbalance between the oxygen requirement of the heart and the oxygen supplied to it via the coronary vessels.
  • Supply and Demand is disturbed.
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5
Q

Classic/Stable Angina

A

Inadequate blood flow in presence of CAD

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6
Q

Prinzmetal angina

A

vasospastic; spasm of coronary vessels; usually an underlying atheroma
Often nocturnal episodes - increase in venous return triggers neurogenic a-adrenergic coronary vasospasm

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7
Q

When does an imbalance in angina occur?

A

When the myocardial O2 requirement increases and coronary blood flow does not increase proportionally.

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8
Q

Why might coronary flow reserve be impaired?

A

endothelial dysfunction - impaired vasodilation

Ischemia occurs at low levels of demand

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9
Q

Unstable angina

A

Acute Coronary Syndrome
Angina at rest
Increased severity, frequency, duration of chest pain in patients with previous stable angina.

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10
Q

In unstable angina, imbalance occurs when there is reduced blood flow due to..

A

partially occlusive thrombi at the site of fissured or ulcerated plaque

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11
Q

Unstable angina and coronary resistance

A

increases

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12
Q

________ and _________. The main theory in treating angina.

A

Supply and demand

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13
Q

Ways to lessen demand (2)

A

Decrease cardiac work

Shift myocardial metabolism

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14
Q

Ways to increase supply

A

Reverse spasm

Treat atherosclerosis

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15
Q

What are the 4 determinants of Myocardial O2 demand?

A

Ventricular wall stress
Heart rate
Contractility
Basal Metabolism

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16
Q

What is ventricular Wall stress?

A

AKA Tension
Tangible force acting on the myocardial fibers, tending to pull them apart.
Energy expended opposing this force

17
Q

Wall stress question?

A

LaPlace : T = (P x r)/2h

P: intraventricular pressure

r: radius of ventricle
h: ventricular wall thickness

18
Q

Conditions that augment LV filling will do what to wall stress?

A

Increase it, therefore more O2 consumption.

19
Q

Conditions that increase pressure in LV do what to wall stress?

A

increase it

20
Q

HR and O2 requirement

A

Increased heart rate causes increased O2 requirement

more contractions per minute, more ATP consumed

21
Q

In a healthy individual… an increased demand for O2 in heart is normally met by….

A

an increase in coronary blood flow

22
Q

Coronary plow is related to ______ pressure and durations of ______

A

perfusion (aortic diastolic pressure); diastole

23
Q

Coronary flow is inversely proportional to

A

coronary vascular resistance

24
Q

How is resistance determined?

A

metabolic products; autonomic activity

25
Q

What happens when the endothelium is damaged (in regards to resistance)

A

Coronary vessels are unable to dilate

26
Q

Peripheral arteriolar and venous tone contribute to ________

A

myocardial wall stress

27
Q

Arteriolar tone directly controls (2)

A

Peripheral vascular resistance
arterial BP
(systolic wall stress)

28
Q

Venous tone determines….

A

Capacity of the venous circulation and location of blood sequestration
(diastolic wall stress)

29
Q

Supply

A

Coronary blood flow
LV end diastolic pressure
PaO2
Membrane diffusion

30
Q

Demand

A

Heart rate

Intraventricular wall stress

31
Q

3 traditionally used drugs for angina

A
  1. Nitrates
  2. Ca channel blockers
  3. B

All three help decrease myocardial O2 demand (decreae HR, ventricular volume, blood pressure, contractility)

32
Q

Nitrates and Ca channel blockers increase….

A

O2 supply to ischemic tissues

33
Q

Why no B2 agonists in angina?

A

Too much cardiac stimulation

34
Q

Nitrates - veno or arterial dilation?

A

Venous – decrease preload

35
Q

MOA nitroglycerine

A

NO in smooth muscle, activates guanylyl clyclase increases cAMP - smooth muscle relaxation, vasodilation

36
Q

No nitrates with what meds?

A

Phosphodiesterase type 5 inhibitors (Vardenafil, viagra, cialis, levitra)

37
Q

How is isosorbide dinitrate different from nitroglycerin?

A

Longer duration of action

38
Q

Isosorbide mononitrate is used for…

A

prophylaxis

39
Q

What does blocking Ca Channels do?

A

Causes smooth muscle relaxation (lessens contraction)

CRAAB 1 Week 3, 4, 5 (4 decks)

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