Angina, Hyperlipidemia, Shock Flashcards
now the major concern with hypertriglyceridemia, levels need to be very high (e.g., > 1000 mg/dL)
acute pancreatitis
a function of diastolic blood pressure, it refers to the pressure that must be generated in the left ventricle before blood begins to exit and can be decreased by arterial vasodilatation
afterload
widely used dihydropyridine calcium channel blocker
amlodipine
pain felt when there is a mismatch between oxygen supply and oxygen demand in the heart, can be worsened by the abrupt withdrawal of beta blockers
angina pectoris
evidence supports prompt administration to broad-spectrum agents for cases of septic shock
antibiotics
side of the circulation in which calcium channel blockers exert their vasodilatory effects to influence afterload with little to no effect on preload
arterial
best selling drug ever drug because of its ability to lower plasma cholesterol levels, now available as a generic
atorvastatin
adrenergic receptor population blocked by atenolol
beta1
class of drugs that is not useful for vasospastic angina, but can decrease frequency of angina attacks, reduce nitroglycerin consumption and increase exercise tolerance in those with frequent attacks of angina due to stress, physical activity due to the activities of daily living
beta blockers
time during which heart receives majority of its blood flow, using drugs to increase it decreases myocardial ischemia
between beats
drug class known for its ability to cause severe constipation, bleeding hemorrhoids, and flatulence, and to interfere with the absorption of fat soluble vitamins and various other drugs
bile acid sequestrants
among the adverse CNS effects some experience when using beta blockers
bizarre dreams
trauma, brain injury, adrenal tumors, coarctation of the aorta, renal artery stenosis and excessive salt intake in somebody with untreated primary hypertension are reasons this can quickly increase to life-threatening levels
blood pressure
among the adverse effects of beta-blockers on the heart
bradycardia
abbreviation for a drug class that has a rare but known complication of gingival hyperplasia
CCB
blockade of its synthesis in the liver by statins causes the liver to take up more LDL from the systemic circulation
cholesterol
a bile-acid sequestrant, several grams of this gritty powder must be consumed per day to lower plasma cholesterol levels; drug class has minimal effect on triglyceride and HDL levels
cholestyramine
deliver the triglycerides in the diet to the myocytes, adipocytes and liver
chylomicrons
refers to phase of septic shock in which profound hypotension and hypoperfusion lead to cold mottled skin with petechiae, initially in feet, that slowly progresses upward to cause irreversible multi-system organ failure
cold
a newer, better tolerated but more expensive alternative to colestipol or cholestyramine
colesevelam
a bile-acid sequestrant, it lowers plasma cholesterol levels by carrying bile into the toilet, thus forcing the liver to synthesize more from cholesterol
colestipol
refers to a “back roads” blood vessel that can help deliver blood flow to ischemic regions of the heart, these capabilities can increase over time and can be augmented with some antianginal drugs
collateral
increases in AV node as a consequence of beta1-receptor-mediated sympathetic tone
conduction
caused by the ability of verapamil to interfere with the pulsatile/peristaltic actions of the GI tract
constipation
refers to the “oomph” generated by the interactions between actin and myosin in the cardiomyocytes for a given degree of preload and afterload, decreased by beta blockers and by the direct actions of calcium channel blockers
contractility
determined by diastolic blood pressure and coronary vascular resistance
coronary blood flow
administering low doses of these improves shock reversal
corticosteroids
typically all that is required to treat all but the most severe cases of hypovolemic shock
crystalloid fluid
a benzothiazepine calcium channel blocker, its effects are rather intermediate between verapamil and the dihydropyridines, especially useful as a class II antiarrhythmic drug
diltiazem
ending of a drug name that suggests it is a member of the dihydropyridine class of calcium channel blockers that binds to calcium channels that are inactivated, as happens more often in blood vessels with stable levels of tone (or spasm)
dipine
used to treat cardiogenic shock, low doses do not preserve renal function as was once thought
dopamine
predictable side effect of dihydropyridine calcium channel blockers
edema
hypertensive ____, refers to elevated blood pressure (e.g., SAP > 1808 or DAP > 120) that is damaging organs
emergency
name give to the circulation in which statins are largely confined
enterohepatic
drug of choice for anaphylactic shock since it reverses bronchoconstriction, also acceptable first choice for septic shock
epinephrine
it is good for you, but will not lower your LDL levels
exercise
generally well tolerated drug that lowers plasma cholesterol levels by inhibiting NPC1L1, a transport molecule in the GI epithelium responsible for absorption of dietary cholesterol and plant sterols
ezetimibe
a drug administered to lower plasma triglycerides, member of a drug class associated with an increased risk for gallstones
fenofibrate
generally well tolerated class of drugs that is best at lowering triglyceride levels, benefits of doing this are called into question by a recent trial suggesting statins were responsible for all benefits seen in diabetic patients with hypertriglyceridemia
fibrates
among the body parts that can become cold with beta blocker use
fingers
intense and associated with the use of niacin for hyperlipidemia, can be minimized by using and NSAID and/or taking extended-release niacin
flushing
a drug administered to lower plasma triglycerides, exerts its effect by interacting with PPAR-alpha
gemfibrozil
can be severe with niacin use to modify plasma lipid levels
GI distress
the lipoproteins that function as peripheral cholesterol scavengers, considered low if < 40 mg/dL
HDL
a determinant of cardiac work, decreased by beta blockers
heart rate
niacin is among the drugs that can cause this, with dark urine, clay-colored stools and jaundice
hepatotoxicity
among the troubling complications associated with the use of niacin for lipid abnormalities
hyperglycemia
very common in the general population due to its association with common conditions such as obesity, pregnancy and diabetes mellitus
hypertriglyceridemia
type of scheduling required for transdermal nitroglycerin patches to minimize tolerance
intermittent
the cholesterol rich lipoprotein, its oxidation and deposition in the vascular tissues is thought to contribute to atherosclerosis; optimal value is < 100 mg/dL, considered high if > 160 mg/dL
LDL
seen in 0.5-2% of patients using statins, the reason serum transaminase levels are monitored
liver injury
functional name assigned to the voltage-gated calcium channels blocked by calcium channel blockers
L-type
cardioselective beta-blocker, now sold in extended release formulation as Toprol XL
metoprolol
a relatively common adverse effect of statins, risk is increased by combining with niacin or fibrates
muscle pain
best drug for raising plasma HDL levels, also lowers LDL and VLDL; data for recent clinical trials indicates that its beneficial effects on those values does not translate into reductions in mortality
niacin
prototypical dihydropyridine calcium channel blocker, typically combined with a beta-blocker when treating angina since it increases heart rate when used by itself
nifedipine
routinely utilized as necessary for prompt relief of angina symptoms or angina prophylaxis due to its ability to preferentially (but not exclusively) dilate the venous circulation to decrease preload
nitroglycerin
short half-life drug that increase cGMP levels in both arteries and veins to cause a mixed vascular relaxation, a drug of choice for hypertensive emergencies because the infusion rate can be adjusted to quickly fine tune the desired blood pressure response
nitroprusside
abbreviation for nitric oxide, the gas released by endothelial cells that diffuses into the underlying vascular smooth muscles cells to cause vasodilatation (i.e., EDRF)
NO
arguably the drug of choice for treating cardiogenic shock and septic shock
norepinephrine
the type of fatty acids contained in fish oil, FDA approved to help lower very high triglyceride levels
omega 3
likely consequence of lowering blood pressure too far too fast in a hypertensive emergency superimposed on top of chronic high blood pressure
organ failure
class of drugs that preferentially dilates veins to increase venous capacitance and thereby decrease cardiac preload
organic nitrates
inability to meet this is responsible for the myocardial ischemia caused by atherosclerosis in the coronary blood vessels (i.e., “chronic stable”), influenced by myocardial contractibility, heart rate and wall tension
oxygen demand
unstable and variant (Prinzmetal) forms of myocardial ischemia cause angina pain due to its disruption
oxygen supply
target of a new exciting class of drugs capable of lowering plasma cholesterol levels ~70% by preventing LDL-receptor breakdown along with LDL in liver; i.e., recycled to cell surface to capture more LDL
PCSK9
example of a beta blocker with “intrinsic sympathomimetic activity”, means it is a partial agonist that will produce a minimal amount of beta mediated response; specific uses are limited, but test fodder and may have utility when patient is at risk for heart block nevertheless needs a drug to suppress heart rate
pindolol
less efficacious than atorvastatin, but arguably a better choice due to lower risk of adverse effects when combined with a fibrate to treat mixed hyperlipidemia
pravastatin
absolute contraindication for statins
pregnancy
refers to how much blood is in the ventricles at the end of diastole, influenced by venous vascular tone, blood volume and skeletal muscle compression of veins with their one-way valves that direct blood flow back toward the heart
preload
prototypical nonselective beta-blocker
propranolol
a drug that has been shown to be beneficial in treating angina despite no significant effect on blood pressure, heart rate, or rate-pressure product; can be added to other anti-anginal therapies
ranolazine
occurs when drug-induced decreases in preload and/or afterload cause a fall in blood pressure
reflex tachycardia
its secretion by the renal afferent arterioles is increased by beta1-adrenergic receptor stimulation and results in the formation of a vasoconstrictor hormone
renin
unlike skeletal muscle, cardiac muscle cannot do this
rest
rare but potentially fatal complication of statin use, often shows up on exams as urinalysis positive for hemoglobin (which is actually myoglobin) but with no red blood cells
rhabdomyolysis
age (> 45 male, > 55 female), family history, hypertension and cigarette smoking are among these for coronary artery disease
risk factors
CCB clevidipine, D1 agonist fenoldopam and beta-blocker esmolol are particularly suited for treating hypertensive emergencies because of this
short half-life
phosphodiesterase type V inhibitor used for erectile dysfunction that can cause severe hypotension in patients using organic nitrates to treat angina pectoris
sildenafil
blockade of a pathological late current of this cation is thought to be the mechanism of action for ranolazine; facilitates relaxation of the myocardium during diastole
sodium
form of guanylate cyclase responsible for nitric oxide-induced cGMP formation
soluble
generally well-tolerated class of drugs that blocks HMG-CoA reductase, solid evidence that it reduces cardiovascular morbidity and mortality
statins
region of the myocardium in which blood flow is increased when preload is decreased
subendocardial
preferred route for nitroglycerin administration for acute angina attacks, bypasses first-pass effect
sublingual
by the time a person has taken this nitroglycerin pill at 5 min intervals for anginal pain, they need to get to ED ASAP since likely a myocardial infarction
third
refers to need for increasing amounts of drug (e.g., nitroglycerin) to get the same effect, a function of the dose and frequency of drug administration
tolerance
route for nitroglycerin administration that has slow onset with long duration, suitable for prophylaxis against frequent anginal attacks
transdermal
also known as combined hyperlipidemia in which there are elevations of both LDL and VLDL, common
type IIb
hypertensive ______ refers to SAP > 180 mm Hg or DAP > 110 mm Hg, but no associated organ damage, requires treatment optimization but generally not hospitalization
urgency
refers to the decrease in post-obstruction blood flow that is seen when other blood vessels are dilated
vascular steal
underlies the severe headaches, facial flushing, hypotension, etc., that are side effects of nitroglycerin use
vasodilatation
vasoactive peptide hormone from posterior pituitary, a second line vasopressor for treating shock
vasopressin
form of angina that benefits from calcium channel blockers and organic nitrates but generally not from beta blockers or ranolazine
vasospastic
phenylalkylamine calcium channel blocker that exerts its effects preferentially on the beating heart because its ability to block the channels is frequency/use dependent, decreases heart rate and exerts negative inotropic effects
verapamil
the triglyceride-rich lipoprotein made by the liver, normally < 150 mg/dL; hepatic production is decreased by niacin
VLDL
to generate or maintain a given pressure, increases dramatically as radius of chamber increases; mathematically defined by LaPlace
wall tension
refers to initial phase of septic shock in which increased cardiac output due to decreased peripheral resistance and plasma volume is lost into “third spaces” ; large amounts of crystalloid fluid are required to maintain cardiac filling
warm
a potential adverse respiratory effect of beta blockers
wheezing
