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Pharmacology part B > Antianginals > Flashcards

Antianginals Flashcards

1
Q

examples of drugs metbaolized to nitric oxide

A

nitroglycerin

dinitrate

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2
Q

example of type5 phosphodiesterase inhibitor

A

sildenafil

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3
Q

examples of dihydropyridines

A

nifedipine
amlodipine
felodipine

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4
Q

examples of non-dihydropyridines

A

verapamil

diltazem

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5
Q

describe stable angina

A

fixed narrowing of teh coronary artery

onse associated with a given level of activity - predictable

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6
Q

descibe unstable angina

A

onset not predictable could be at rest

related to coronary atherosclerotic plaque rupture, dislodged clots

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7
Q

describe vasospastic angina

A

occurs at anytime

spasms of coronary artery

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8
Q

risk factors for angina

A 
smoking
dyslipidemia 
diabetes
hypertension
sedentary 
obesity 
stress
family history
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9
Q

four treatments for angina

A

nitrates/nitrites
beta blockers
calcium channel blockers
ASA

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10
Q

what two ways can nitroglycerin be used and what are the formulations

A

acute pain - sublingual

prevent pain with exercise - patch, oral

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11
Q

how can isosorbide dinitrate be used and what are the formulations

A

prophylactically to prevent pain with exercise

sublingual and oral

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12
Q

what does nitric oxide do

A

increase cGMP which mediates dilation

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13
Q

nitrate mechanism of action

A

metabolized to nitric oxide
relax veins and arteries
coronary steal prevented

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14
Q

result of relaxing veins

A

venodilation
decrease preload
decreased filling pressure
decreased myocardial oxygen demand and less decrease in endocardial flow during systole

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15
Q

define endocardium

A

blood flow only during diastole

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16
Q

define pericardium

A

blood flow during diastole and systole

17
Q

what is coronary steal

A

beyond to occlusion there is maximal dilation and reflux dilation in the healthy area steals the blood from the ischemic area

18
Q

how is coronary steal prevented by nitrate

A

effects the larger arterial vessels more than the smaller so blood flows to bother healthy and ischemic regions

19
Q

why is it best to not use nitrates over night

A

tolerance develops

20
Q

adverse effects of nitrates

A

orthostasis
throbbing headache
reflex activation of SNS
salt and water retention

21
Q

what is the double product

A

nitrates decrease oxygen demand but do not increase the supply

22
Q

nitrates are light and heat sensitive how can you tell if they are potent

A

tingling sensation should be felt under the tongue

23
Q

what does aldehyde dehydrogenase ALDH2 do

A

convert nitrate to nitric oxide

breakdown aldehyde associated with alcohol metabolism

24
Q

why are most asians poor responders to nitrates and how can you tell if they will be

A

decreased ALDH2

if get a flushed response to alcohol

25
Q

what sit he first line treatment in chronic stable angina

A

beta blockers

26
Q

mechanism of beta blockers

A

decreased oxygen demand by decreasing heart rate, blood pressure and contractility
increase flow to ischemic region

27
Q

when do beta blockers imrpove survival

A

follwowing an MI

28
Q

adverse effects of beta blockers

A

slowing of heart causes increased end diastolic volume and incresaed oxygen demand
may worsen vasospastic angina

29
Q

how do dihydropyridines help in angina

A

decrease afterload

decrease coronary vascular tone

30
Q

why are dihydropyridines good for prinzmetal angina

A

decreases coronary artery spasm

31
Q

how does verapamil help in angina

A

decreased oxygen demand

32
Q

how does diltiazem help in angina

A

decreases oxygen demand

coronary arterial dilator

33
Q

adverse effects of calcium channel blockers

A 
cardiac suppresion 
constipation 
ankle edema
sympathetic reflexes
dizziness
hypotension
34
Q

why would you add amlodipine and nitrate with a beta blocker

A

stops the reflex sympathetic activity that would increase oxygen demand

35
Q

antiplatelet therapy in unstable angina

A

ASA, clopidogrel

IV heparin

36
Q

things to avoid in vasospastic angina

A

beta blockers
ASA
dumatriptan

Pharmacology part B (17 decks)

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