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Pharmacology 3 > CAD Drugs > Flashcards

CAD Drugs Flashcards

1
Q

Diagnostic results for stable angina:

A

normal ECG

normal troponin

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2
Q

Diagnostic results for unstable angina:

A

normal troponin

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3
Q

Diagnostic result for NSTEMI:

A

elevated troponin

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4
Q

Diagnostic result for STEMI:

A

elevated ST segment

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5
Q

Myocardial oxygen supply is determined by

A

Absolute volume of coronary blood flow

Oxygen carrying capacity of blood

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6
Q

Myocyte oxygen demand is influenced by:

A

Heart rate
Myocardial contractility
Myocardial wall stress

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7
Q

Treatment for supply side ischemia:

A

Anti-platelet and anti-coagulant drugs

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8
Q

Treatment for demand side ischemia:

A

CAD drugs

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9
Q

ST elevation indicates these conditions:

A 
May be normal
Acute myocardial infarction
Variant angina pectoris
Acute coronary spasm
Pericardial effusion
Left ventricle aneurysm
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10
Q

ST depression indicates these conditions:

A

Always abnormal
Ischemia
Left ventricular hypertrophy
Digitalis toxicity

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11
Q

More invasive CAD interventions:

A

Percutaneous Coronary Intervention

Coronary Artery Bypass Graft

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12
Q

Used as noninvasive estimate of myocardial oxygen consumption (MVO2):

A

Heart rate x Systolic blood pressure

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13
Q

Heart measure related to myocardial contractility:

A

Stroke volume (CO=HRxSV)

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14
Q

Considered the prototype of the nitrates group:

A

Nitroglycerin

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15
Q

Oral bioavailability is low in these nitrates:

A

Nitroglycerin

Isosorbide dinitrate

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16
Q

Nitrate not susceptible to first pass metabolism (100% BA):

A

Isosorbide mononitrate

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17
Q

Nitrate used as maintenance drug:

A

isosorbide mononitrate

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18
Q

Half-life and excretion of nitrates:

A

2-8 minutes; kidney

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19
Q

___ and ___ administration avoid nitrate first-pass metabolism, and ___ route provides rapid absorption:

A

Sublingual and transdermal; inhalational

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20
Q

Groups in the cell membrane that allow nitrate to enter:

A

sulfhydryl groups

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21
Q

Nitrate stimulated cGMP causes:

A

Intracellular Ca inhibiton (vasodilation)
Inhibition of calcium channels
Inhibition of mitochondrial respiration

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22
Q

Exogenous nitroglycerin is transformed by:

A

mitochondrial aldehyde dehydrogenase

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23
Q

Effects of nitrates on circulation:

A

Reduced venous return (reduced preload)
Increased systemic arterial and CA diameter (reduced afterload, extrinsic compression)
Recruitment of collateral vessels

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24
Q

Reduced preload effects on myocardial supply/demand:

A

Increased coronary blood flow (supply)

Reduced myocardial wall stress (demand)

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25
Q

Adverse effects of nitrates:

A

Headache (meningeal artery)
Tachycardia
Orthostatic hypotension (vasodilation)
Rebound withdrawal

26
Q

Mechanisms of nitrate tolerance:

A

Volume expansion (retention of salt and water)
Neurohumoral activation (reflex tachycardia)
Free radical generation (damages heart)
Depletion of sulfhydryl groups

27
Q

Phenomenon responsible for nitrates paradoxical aggravation of angina:

A

Coronary steal

28
Q

Nitrates should not be administered to:

A 
Systolic BP less than 90 mm/Hg or 30 mm/Hg below baseline
Severe bradycardia (less than 50 bpm)
Tachycardia
RV infarction
Hypertrophic cardiomyopathy
Aortic stenosis
29
Q

These drugs may cause severe hypotension when given with nitrates:

A

PDE-5 inhibitors

30
Q

β1 receptors promote the production of ___ and activated ____ channels:

A

cAMP; L-type Calcium

31
Q

β-blockers enhance coronary blood flow by increasing ____, but this in turn leads to increased ___:

A

diastolic perfusion; preload

32
Q

β-blockers used to treat CAD must be WITHOUT:

A

Intrinsic sympathomimetic activity

33
Q

β-blocker of choice for CAD patients with asthma:

A

Celiprolol (β2 agonistic activity)

34
Q

CI in those taking β-blockers:

A

Verapamil and dilitazem

Anti-arrhythmics (amiodarone)

35
Q

L-type Ca receptors are dominant in:

A

Cardiac and smooth muscle

36
Q

CCB decrease effects on the heart:

A 
Decreased contraction (inotropy)
Decreased HR (chronotropy)
37
Q

Ca has an anti-atherogenic effect and is needed in these coagulation factors:

A

Factors VII, IX, X, XIII, II and I

38
Q

DHP CCB used in cerebral blood vessels:

A

Nimodipine

39
Q

DHP CCB used in coronary vessels:

A

Nicardipine

40
Q

CCB effect on cardiac preload:

A

Do not affect cardiac preload (little effect on venous beds)

41
Q

Why does Nifedipine increase HR and contractility?

A

Very rapid vasodilation leading to reflex tachycardia

42
Q

CCB are used to treat these types of angina:

A

Vasospastic:
Variant
Exertional

43
Q

Contraindicated in unstable angina or threatened MI:

44
Q

Adverse effects of CCBs:

A 
Hypotension (DHP)
CHF exacerbation (verapamil and diltiazem)
Conduction abnormalities (V & P)
Edema
GERD
45
Q

Nifedipine should be used in conjunction with a ___ in patients with ischemic heart disease:

A

β-blockers

46
Q

Indicated drugs in angina of effort:

A

Nitrates
CCB
β-blockers

47
Q

Indicated drugs in vasospastic angina:

A

CCB

Nitrates

48
Q

Indicated drugs in unstable angina:

A

β-blockers
Anti-platelets
NTG
ACE inhibitors

49
Q

Nitrates + β-blockers cancel out these undesirable effects:

A

no effect on contractility

no effect on ejection time

50
Q

This drug combination may result in AV block:

A

Diltiazem/Verampamil + β-blockers

51
Q

Prototype ACE inhibitor:

52
Q

More common type of AR blocker:

A

non-peptide (-sartan drugs)

53
Q

ACE inhibitors are give to MI patients who are NOT:

A

hypotensive

54
Q

ACE inhibitor precautions:

A

Pregnancy

Bilateral renal artery stenosis

55
Q

P-FOX prototype:

A

Trimetazidine

56
Q

P-FOX adjunct used in surgical intervention:

A

Ranolazine

57
Q

Benefit of P-FOX drugs:

A

promotes shift towards more oxygen-efficient glucose pathway

58
Q

How does ranolazine blunt the effects of ischemia?

A

Inhibits the late Na current responsible for Ca overload (electrical and mechanical dysfunction)

59
Q

PCI is indicated in:

A

Single or double vessel disease

Inability to tolerate surgery

60
Q

CABG is indicated in:

A

Triple vessel or left main disease
Diabetes mellitus
Failed PCI

Pharmacology 3 (5 decks)

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