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Pharmacology > Angina + Asthma + Histamine > Flashcards

Angina + Asthma + Histamine Flashcards

1
Q

Disruption of stable plaque can cause these 4 processes

A

Platelet Adhesion
Fibrin Deposition
Thrombus Formation
Closure of blood vessel

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2
Q

Ration of lack of oxygen leading to build up of acids and pain

A

Angina

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3
Q

Factors that determine the progress of CAD

A 
Concentration of lipid
Endothelial function
Blood pressure
Activity of inflammatory system
Reactivity of pro and anti-inflammatory systems
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4
Q

Is the primary symptom of ischemic heart disease caused by imbalance of myocardial Oxygen supply and demand

A

Angina Pectoris, Also known as chest pain

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5
Q

What does INOCA mean?

A

Ischemia with Non Obstructive Coronary Artery

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6
Q

Happens when the arteries are pinched during systole

A

Myocardial Bridge

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7
Q

Determinants of myocardial oxygen

A

Wall stress
Heart rate (Chronotropy)
Contractility (Inotropy)

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8
Q

Determines left ventricular systolic wall stress

A

Arteriolar tone

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9
Q

Determines right ventricular diastolic wall stress

A

Venous tone

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10
Q

Steps in relaxation of smooth muscle

A

Increase cGMP & cAMP
Decrease intracellular Calcium
Stabilizing Depolarization

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11
Q

Proportion of blood flow and arterial radius

A

Inversely proportional - As blood flow increases, artery radius decreases

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12
Q

Pain in exertion and emotional stress. Characterized by build up of plaque within the endothelium and increase in myocardial oxygen demand

A

Stable Angina

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13
Q

Rupture of atherosclerotic plaque causing platelet adhesion and aggregation. More thinner capsule are vulnerable

A

Unstable Angina

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14
Q

Focal or diffuse vasospasm episodically. Endothelial dysfunction is one of the proposed mechanism causing vasospasm

A

Variant/Prinzmetal/Vasospastic Angina

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15
Q

This is a characteristic feature of Acute Coronary Syndrome and would classify it as Unstable Angina

A

Resistance to Nitrates

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16
Q

Activates the soluble isoform of guanylyl cyclase increasing intracellular cGMP thereby relaxing the smooth muscle

A

Organic Nitrates

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17
Q

Activation of guanylyl cyclase through NO also has an effect on the…

A

Bronchi and GI tract, causing relaxed breathing and defacation

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18
Q

These PDE5 inhibitors can potentiate the action of nitrates causing excessive vasodilation

A

Sildenafil
Tadalafil
Vardenafil

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19
Q

This dose of NO dilates veins and conductance arteries

A

Low dose (Small and medium arteries not affected)

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20
Q

This dose of NO venodilates causing decreased venous return leading to a fall in left and right ventricular chamber size and end-diastolic pressure, reduced wall stress, and reduced cardiac o2 demand. But may cause flushing and headache

A

Low to Medium Dose (Chronotropy unchanged, PVR and CO slightly reduced)

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21
Q

This dose increases venous pooling and decreases arteriolar resistance causing hypotension-like symptoms and Bezold-Jarish reflex

A

Higher Dose

22
Q

The action of nitrates are?

A

Reduce preload
Dilation of Pulmonary vascular resistance
(Some reduction of afterload)

23
Q

Powerful stimulus for coronary vasodilation

A

Ischemic Heart Disease

24
Q

These non-selective vasodilators can cause Steal Phenomenon redistributing blood flow away from ischemic myocardium

A

Adenosine

Dipyridamole

25
Q

Used as a stress test to provoke angina and diagnose ischemia

A

Dipyridamole

26
Q

A function of dosage and frequency use due to prolonged treatment

A

Tolerance

27
Q

Mechanism of Tolerance

A

Volume expansion
Neurohumoral activation
Cellular depletion of SH groups
Generation of free radiacals

28
Q

How to avoid tolerance of nitrates?

A

Interrupted treatment of 8-12 hrs/day

Avoid high doses

29
Q

Dosing of nitrates for patients with increased left ventricular filling pressure

A

Take nitrates at night

30
Q

Produces NO during sexual arousal

A

Cells of corpus cavernosum

31
Q

PDE5i approved in patients with pulmonary hypertension

A

Sildenafil

32
Q

PDE5i with longest half-life and longer onset of action

A

Tadalafil

33
Q

Vascular response from highest to lowest from nitrates

A

Veins > Arteries

34
Q

Nitrate vasodilation from highest to lowest reaction in epicardial coronary arteries

A

Eccentric > Concentric

35
Q

This class of anti-angina causes relaxation of smooth muscle by inhibiting calcium influx. Has high first pass effect, high plasma protein binding, and extensive metabolism

A

Calcium Channel Blockers

36
Q

Dihydropyridine CCB

A 
Amlodipine
Felodipine
Lercanidipine
Nicardipine
Nifedipine
Nisoldipine
Isradipine
37
Q

Non-dihydropyridine

A

Verapamil

Diltiazem

38
Q

Voltage gated channel sensitive to dihydropyridines and binds to Alpha 1 subunit

A

L-type

39
Q

Verapamil binds to what segment of the L-type channel?

A

Transmembrane IV, Domain S6 (IVS6)

40
Q

Diltiazem binds to what L-type channel?

A

Cytoplasmic bridge and Domain 3 (IIIS)

41
Q

This CCB does not affect the rate of recovery of the slow Ca channel. It has a negative chronotropic effect

A

Nifedipine

42
Q

Reduces magnitude of calcium entry and rate of recovery of the channel. Depresses SA and slows AV node conduction used for the treatment of SVT, Hypertrophic cardiomyopathy, Prophylaxis for migrane, Second choice for asthmatic and depression patients

A

Verapamil

43
Q

Used in patients with neurological deficits secondary to cerebral vasospasms?

A

Nimodipine

44
Q

Provides symptomatic relief in Raynaud’s

A

Nifedipine
Diltiazem
Amlodipine
Felodipine

45
Q

When is oral and IV veramapil used?

A

Oral- Patients without HF

IV- Patients with HF

46
Q

Toxicity of CCB as a result of increase hydrostatic pressure in lower extremities

A

Peripheral toxicity

47
Q

Synthetic derivative of papaverine

A

Verapamil

48
Q

Only class effective in exertion or effort angina. Has negative inotropic and chronotropic effect

A

Beta blockers

49
Q

This phenomenon increases coronary collateral resistance and prevents blood from being shunted away from the ischemic myocardium

A

Reverse steal or Robin Hood Phenomenon.

50
Q

Recommended as first line treatment for patients with stable CAD, but not useful for prinzmetal angina

A

Beta blockers

51
Q

These beta blockers are standard for the treatment of angina without intrinsic sympathomimetic activity

A

Beta 1 selective/ Beta 1 Blockers

Pharmacology (1 decks)

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