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CAD And HF Flashcards

1
Q

Angina can lead to

A

MI, CHF, arrhythmias

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2
Q

At rest
Coronary BF
% CO
%02 extracted from myocardial tissue beds

A

70 ml/min/100g
5% co
70%

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3
Q

Coronary bf at exercise
Coronary bf alteration
CO demand increase, what also increases

A

2-4x
4-7x
Preload, hr, contractility

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4
Q

When coronary arteries fill

What perfusion pressure to LV is

A

Diastole

DBP-LVEDP

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5
Q

Factors that increase myocardial 02 demand 4

A

Tachycardia, high afterload, high preload, increased contractility

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6
Q

What increases myocardial 02 supply

6

A

Hgb conc, 02 sat, bradycardia, inc DBP, low normal preload, decreased contractility

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7
Q

CAD

Hr goal, indicated, contra/cautious use

A

Slow
BB and CCB
Isoproterenol, dobutamine, ketamine, pancuronium

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8
Q

CAD goals
Preload goal
Indicated
Contraindicated

A

Low normal
Ntg and diuretics
Volume overload

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9
Q

CAD goals
Afterload goal
Indicated
Contra/caution

A

High normal
Phenylephrine
Nitroprusside, high dose volatile agent

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10
Q

CAD
Contractility goal
Indicated
Contra

A

Normal to decreased
BB, CCB, high dose volatile
Contra: epi, dopamine

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11
Q

Stable angina tx

A 
A- ASA, antianginals (nitrates, Ccb, bb)
B- BP control 
C- cholesterol, no cigs 
D- diet, dm 
E- edu, exercise
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12
Q

Organic nitrates
What they do
3 ex

A

Inc conc NO in smooth muscle

Ntg, isordil, imdur

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13
Q

Organic nitrates
What they do to veins and arteries, cv fx
Isordil DOA

A

Relax venous capacitance vessels and large coronary arteries to decrease preload and ventricular wall tension. Decrease demand, inc supply
6 hrs

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14
Q

Ntg routes

6

A

SL: tab, spray
Oral
Topical: ointment, patch
IV

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15
Q

NO signal pathway through

A

Glutathione and glutathione s transferase to NO

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16
Q

Nitrate MOA

A

Release NO after metab. Activate guanylate cyclase, inc cGMP, inc protein kinase G

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17
Q

Where nitrate signaling cascade ends

A

Dephosphorylation of myosin light chains, sequesters intracellular Ca, vessel relaxes

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18
Q

Anti angina actions of nitrates

A

Reduces 02 consump (dec preload thru vasodilation, dec afterload thru arterial dilation)
Dilates collateral vessels serving ischemic areas, attentuates spasms, inc rate of relaxation like NO

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19
Q

NTG
Metabolism
1/2t

A

90% degraded by liver to inactive metabolites.
E 1/2 1.5 min IV
SL and transdermal bypasses 1st pass and liver

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20
Q

Ntg

SE

A

HA
Postural hypotension
Methomoglobinemia (high iv dose and liver disease)

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21
Q

Nitrate tolerance

About, do what

A

Limits efficacy. Tolerance to AE.

Have intervals w no use, remove path at night. Oral siorbine: long t 1/2 w low levels

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22
Q

Nitrate drug interac
3
What happens
Tx

A

Viagra, cialis, levitra
Inhib phosphodiesterase, breaks down cGMP
Additive effect. Tx phenylephrine

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23
Q

Beta adrenergic antag
Overall effect
Indic

A

Favorable 02 supply and demand balance

Prevents unstable and stable angina

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24
Q

Beta adrenergic antag

What it does to heart itself

A

Dec 02 demand by dec CO. Dec catechol inc in SA ndode and AV node- HR dec. Improves diastolic filling time to inc supply, CO drop more dramatic w activity than rest

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25
``` BB Use primarily what Improves survival in who Dont do what Avoid in what ```
B1 selective, metoprolol and atenolol CAD D/c suddenly Variant angina
26
BB | SE 6
Depression, insomnia, masks hypoglycemia signs in DM, exercise intolerance, bronchospasm asthmatics
27
CCB L type | Action (MOA)
Bind to A1 subunit of l type channel in mode 0 when channel wont respond to depolarization stimula
28
``` CCB Effect at SA AV Muscle Coronary vasculature ```
Dec hr, Dec conductivity and hr Dec contractility Dilates vessels and arterioles
29
CCB | AE 5
AV block, cardiac failure, HA, constipation, hypotension
30
Dihydropyridines 3 ex What they are May cause what
Amlodipine, nifedipine, nicardipine More selec for ca ch than vasculature than non-dihydropyridines Reflex tachycardia
31
Non dihydropyridines 2 ex More selec for More at risk for, avoid what
Verapamil and dilt Ca ch in heart Heart block, avoid use of BB
32
Asa | Role, MOA
Plt activation contributes to thrombus formation | Antiplatelet activity imp CAD
33
ASA Inhib what Duration Dose
Irreversible inhibited TxA2, lifespan of plt 10 days, 80 mg
34
Unstable angina | 4 drugs you would use
Antianginals, heparin or asa, hpIIb/a agonists like integrillin, plavix
35
STEMI tx
Surgery, streptokinase, tPA
36
Plavix MOA Indic
Irreversible plt ADP receptor a antag All ACS pts w ASA allergy Reduces recurrent coronary events
37
Plavix | Caution w what
Combo w ASA/GPIIb/a inc risks of major bleeding. May still usein some pts
38
GP IIb/IIIa inhib 3 ex Indic
Reapro, integrillin, aggrastat | Reduce risk mi in unstable angina and urgent revasc w nstemi
39
Tx acute angina
Nitrates, bb, Ccb
40
Tx unstable angina
Nitrate, bb, Ccb, aspirin or plavix, hepatic or thrombolytics, glyco II/III inhib
41
Tx variant angina
Nitrates and Ccb
42
Systolic dysfunc EF < ___% Causes
40 CAD NICM: htn, valvular disease, etoh, thyroid disease, cardiotoxic drugs
43
Diastolic dysfunc Impaired ___ 2 causes
Filling Cardiomyopathies Incomplete relaxation of LV during ischemia (myocytes need ATP to relax)
44
HF manifestations
Dyspnea: DOE, orthopnea, PND | Fatigue, fluid retention
45
NYHA Class I Class II
No symp w ordinary activity | Symp w ordinary activity, slight limitation
46
NYHA classification Class III Class IV
Symp w less than ordinary activity, marked limit | Symp w any activity, also at rest
47
Physio drug goals Reduce ___: 3 Reduce ___:3
Preload: diretics, aldosterone antag, venodilators Afterload: ACEi, BB, vasodilator
48
Physio drug goals | Increase ___: 3
Inotropy: cardiac glycosides, sympathomimetic amines, phosphodiesterase inhib
49
CHF goals HR: __ to ___ Drugs: Contra:
Normal to elevated Dopamine and dobutamine BB (high doses)
50
CHF goals Preload goal: ___, indicated, contra
Normal IVF if decreased NTG (if now preload), thiopental
51
CHF goals Afterload | Goal, indic, contra
Low ACE, ntp, amrinone Phenylephrine
52
CHF goals contractility | Goal, indic, contra
Increased Dopamine, dobutamine, epi, amrinone C: high dose inhaled agents and high dose BB
53
Diuretics Consider __ before giving No evidence of __ benefit w __ or __ diuretics
Preload | Mortality, thiazide, loop
54
Diuretics __ ones most commonly used 3 ex. Inhibit what. Inc excretion of what
Loop Furosemide, bumetanide, torsemide Inhib na k 2 cl cotransporter in loop of henle. Excrete na, k, water
55
``` Diuretics Distal tubule: 5-10% __ excretion 2 drugs 2 that spare k Lose effectiveness when what ```
Na Thiazides, zaroxolyn Spironolactone, eplerenone Creat <30 ml/min
56
Diuretics | Loop: 20-25% __ excretion
Na
57
Spironolactone | How it acts
K sparing, competitive antagonist at aldosterone receptor | Dec k/na exchange in distal tubule and collecting duct of nephron
58
Spironolactone Inc mortality or not Monitor what w ACE
Decreases mortality | Monitor k, both decrease k excretion
59
Aldactone SE
Gynecomastia and impotence from inhibiting androgen and mineralcorticoid receptors
60
Inspa | What is is comp to aldactone
Also an aldosterone antagonist. More selective- less SE
61
NTG | CV effects
Inc venous capacitance, reduces venous return to heart. Dec myocardial o2 demand. Alleviates ischemia, improves diastolic relaxation and improves LV compliance
62
Ntg | Caution in these pts
Dont decrease preload too much
63
ACEi | Actions
Reverses RAA vasoconstriction and vol retention. Reduces afterload which increases SV, inc GFR , inc natiuresis/diuresis. Dec preload. Mortality benefit
64
ARB | Comparison to ACE
Similar hemodynamics, no bradykinin related vasodilation so less preload reduction. Mortality benefit. May be additive when used w ACEI
65
B blockers | Benefits r/t
Inhib renin release. Attenuates signaling from catecholamines and prevents ACS.
66
B blockers Dont use in who Benefit
Acute decompensated HF | Mortality benefit
67
Hydralazine and isorbide initiate Action Use when Benefit
Vasodilator. When pt doesnt tolerate ACEi Mortality dec only in African Americans
68
What is bidil, why its useful
Hydralazine (arterial dilator) and isorbide dinitrate (venodilator).
69
Digoxin | Action
Na k adenosine triphosphate inhib. Dec SNS outflow, inc PNS outflow. Dec conduction, inc av refractory period. Dec hr/preload/afterload. Inc ca. Dec na abs
70
Digoxin Therap level Onset Half life
0.5-1.2 30-60 min 36 hrs, takes 7 days to reach steady state serum conc
71
Digoxin Excretion AE Antidote
90% really excreted Hypokalemia, av block, ventricular ectopy Digibind/fab
72
Digoxin | Pharm interactions
Inc risk av block w bb Bb and ccb decrease contractility Abx inc absorption
73
Digoxin | Drugs that inc levels and how
Verapamil, quinidine, amio. Affect Vd and/or renal clearance
74
Dobutamine | Action
Stim B1, inc contractility. Stim B2- arterial vasodilation, dec afterload. Short term tx acute HF
75
Phosphodiesterase inhib | Do what on cell level
Inhib degradation of cAMP and cGMP in cardiac myocytes and vascular smooth muscle
76
Phosphodiesterase inhib | Cardiac effects
Inc contractility w little inc in 02 demand. Arterial and venous dilation dec after and preload. Mild bronchodilation. Improved diastolic relaxation.
77
Pde inhib | Good in OD of what
Beta blocker
78
Amrinone | Cv effects
Inc CO and LV EF Dec LVEDP and wedge pressures. HR inc slightly, BP dec slightly
79
Amrinone 1/2 life Excretion AE
6 HRS Renal, unchanged Hypotension and thrombocytopenia. May cause arrhythmias from inc ca
80
Milrinone Comp to amrinone E 1/2 Excretion
Less tachycardia and thrombocytopenia 2.7 hrs 80% excreted unchanged in kidneys
81
Milrinone | Long term use shows what
No improvement of M and M. May increase it. More helpful for pulm htn management

Pharmacology (19 decks)

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