Anti-hypertensives/ Anti-anginals

Question 1

Types of Angina

What causes stable angina?

Answer 1

Narrowing of coronary artery, causes ischemia during times of stress or physical exertion, predictable

Question 2

Types of Angina

What causes Acute Coronary Syndrome (Variant angina)?

Answer 2

Vasospasm, reduces coronary blood flow

Question 3

Types of Angina

What causes Unstable Angina?

Answer 3

Rupture of atherosclerotic plaque resulting in platelet adhesion and aggregation which reduces blood flow. Can be progressive and lead to MI

Question 4

How do you treat variant angina?

Answer 4

Ca channel blockers

Question 5

How do you treat unstable angina (Rx)

Answer 5

aspirin and statin therapy

Question 6

Treatment of stable angina

Answer 6

Nitroglycerin (decreases contractility of smooth muscle tissue, dilates venous system primarily in CV system)

Question 7

How does the reservoir of oxygen in the heart differ from that of other organs?

Answer 7

All of the oxygen is used in normal circumstances, with little left over. Other organs are overperfused. The only way to increase O2 is to increase coronary flow

Question 8

How do you decrease ischemia in the heart

Answer 8

Decrease demand for O2 = decrease heart rate

Question 9

what is pressure x radius / wall thickness

Answer 9

tension

Question 10

how do you calculate coronary flow

Answer 10

aortic pressure (diastole) - LV pressure /coronary vascular resistance

Question 11

What does nitroglycerin do to preload

Answer 11

decreases

Question 12

How does the heart respond to localized ischemia?

Answer 12

Ischemic area sends out metabolic signals (adenosine and potassium) which cause dilation in the area of ischemia only so other areas don’t “steal” the increased blood flow

Question 13

Why do we care about hypertension?

Answer 13

Most common CV disease
Primary cause of stroke
Decreasing diastolic number 5-6 mmHg decreases stroke risk by 35-40%

Question 14

what is the formula to calculate BP

Answer 14

BP = CO x TPR

Question 15

How do you calculate CO

Answer 15

CO = HR x SV

Question 16

what is the top choice for treating HTN?

Answer 16

diuretics (thiazides)

Question 17

where to thiazides target?

how do they work?

Answer 17

distal convoluted tubule

block Na-Cl cotransport causing lower blood volume

Question 18

contraindication of thiazide diuretics

Answer 18

renal function impairment

Question 19

side effects of thiazide diruetics

Answer 19

K loss
sexual dysfunction
increased risk of arrhythmias and QT prolongation (don’t combine with other drugs that do this)

Question 20

What can you do for patients if you are concerned about K loss?

Answer 20

Prescribe a K sparing diuretic to add (not given alone)

Block Na channels in collecting duct to reduce K loss

Question 21

which ace inhibitor and ARB do we need to know for this test?

Answer 21

captopril (ACEI) and losarten (ARB)

Question 22

How does captopril work?

Answer 22

blocks conversion of angiotensin I to angiotensin II, prevents vasoconstriction
reduces aldosterone secretion -> reduces Na retention

Question 23

In patients with which comorbidity should you definitely consider an ACE?

Answer 23

diabetes- slows progression of renal disease (but they also can cause renal failure in patients with renal artery stenosis and decreased GFR)

Question 24

What is the common side effect associated with ACEI that requires change of therapy?

Answer 24

dry cough (high bradykinin levels)

Question 25

How does losarten work?

Answer 25

ARB
Work similarly to ACEI
No increased bradykinin = no cough
Not as good in diabetics

Question 26

Should you use ACEI or ARBs in pregnancy

Answer 26

Neither! Don’t do it!

Question 27

What B-adrenergic receptor antagonist do we need to know? (Why can’t he just call them B blockers??)

Answer 27

propranolol

Question 28

How does propranolol work?

Answer 28

reduces myocardial contractility and CO by blocking B1

Question 29

beta blocker side effects

Answer 29

erectile dysfunction, depression, and insomnia

Question 30

who to not use B blockers in and why?

Answer 30

Asthma- bronchoconstriction

Elderly and African Americans- doesn’t work as well, unknown why

Question 31

what ca channel blockers do we need to know?

Answer 31

verapamil

amlodipine

Question 32

how do ca channel blockers work?

Answer 32

decrease contractility due to low calcium

lowers vascular resistance

Question 33

what is the most compelling difference between verapamil and amlodipine

Answer 33

nifedipine/amlodipine causes a sympathetic response to low BP and causes tachycardia
verapamil does not due to direct negative chronotropic response

Question 34

side effects of ca channel blockers

Answer 34

cardiac depression, cardiac arrest,
bradycardia, peripheral edema, constipation (particularly common with verapamil), AV
block and congestive heart failure

Question 35

ca channel blockers can increase risk of ischemia! When should you choose them?

Answer 35

for angina and arhythmia treatment, especially in the elderly and African American population

Question 36

what vasodilators do we need to know?

Answer 36

hydralazine
minoxidil
sodium nitroprusside

Question 37

how do vasodilators work

Answer 37

direct relaxation of arterial smooth muscle tissue

Question 38

Why are vasodilators rarely prescribed

Answer 38

The reflex evoked increases in heart rate, contractility, plasma renin activity and fluid retention all counteract the
antihypertensive effect, must be administered with a sympatholytic (hydralazine and minoxidil)

Question 39

How is sodium nitroprusside different from hydralazine and minoxidil

Answer 39

reduces contractility of arterioles and venules but only modest impact on HR
must be given by continuous IV (breaks down with exposure to sunlight)