Angina pharm and cardiac glycosides

Question 1

NO effect at high doses

Answer 1

-Dilates large epicardial arteries

At lower doses - nitrates dilate veins - main effect is decrease in preload leading to decreased myocardium oxygen demand

Question 2

Half-life comparison of isosorbid dinitrate with isosorbide-5-mononitrate

Answer 2

Isosorbide dinitrate = 10-60 minute duration

Isosorbide-5-mononitrate = 6-10 hour duration

Question 3

When is nitrate Rx use contraindicated?

Answer 3

Right ventricular infarction

Hypertrophic cardiomyopathy

Concurrent PDE5 inhibitor usage

Question 4

Why can nifedipine increase risk of MI?

Answer 4

Rapid onset and short action

Question 5

What calcium channel blocker can inhibit simvastatin and digoxin metabolism?

Answer 5

Ranolazine

Question 6

What calcium channel blocker is used to Tx refractory angina?

Answer 6

Ranolazine

Question 7

Ischemic heart disease decision tree

Answer 7

Question 8

MOA of digoxin

Answer 8

Inhibits Na/K ATPase

Can lengthen phase 4 and 0 of action potential

Has direct effect to limit Na/Ca exchanger - leading to increased atrial and ventricular intracellular calcium levels

Question 9

ANS effects of digoxin

Answer 9

Increased vagal tone - slows atrial rate and AV conduction

Sensitization of barorecptors

Facilitates muscarinic transmission

Question 10

Therpeutic uses of digoxin

Answer 10

-Atrial fib/flutter (dicreased SA node automaticity and AV node conduction)

-Heart failure (increased contractility; positive inotrope)

Question 11

Adverse effect of digoxin

Answer 11

GI effect - most common

Visual disturbances

Arrhythmias - AV block most common can cause any arrhythmia

Hyperkalemia (correlated w/ poor outcomes)

Question 12

Digoxin and hypercalcemia

Answer 12

Hypercalcemia facilitates cardiotoxic actions of digoxin (arrhythmias)

Elevated magnesium has opposite effect

Question 13

How is digoxin excreted?

Answer 13

Renally

Question 14

Hyperkalemia and digoxin

Answer 14

Hyperkalemia decreases effect of digoxin and hypokalemia increases it

Question 15

Digoxin contraindacations

Answer 15

1. Advanced AV block
2. Bradycardia or sick sinus syndrome
3. PVC’s and v-tach
4. Hypokalemia
5. Wolff-Parkinson-White syndrome with a-fib

Question 16

What calcium channel blockers decrease HR?

Answer 16

non-dihydropyridines (i.e. verapamil and diltiazem)

Question 17

What drug is used in combination with low-dose aspirin for the prevention of atherothrombotic events in people w/ acute coronary syndrome?

Answer 17

Ticagrelor

Reversible ADP receptor (P2Y₁₂) inhibitor

Question 18

Which of the following ECG manifestations is most likely to be a pharmacological manifestation on a patient being treated with too large of a dose of Diltiazem and not be seen with Amlodipine?

Answer 18

Sinus bardycardia

Question 19

A 55-year-old male with a history of variant angina is experiencing chest pain triggered by emotional stress. His physician prescribes a medication that prevents coronary vasospasm. Which of the following medications is most appropriate for this patient?

a. Ranolazine
b. Digoxin
c. Esmolol
d. Isosorbide dinitrate
e. Verapamil

Answer 19

e. Verapamil

CCB is first-line = nifedipine

Question 20

Answer 20

D. Pindolol

Question 21

Answer 21

D. Simvastatin

Ranolazine interferes w/ digoxin metabolism too