Car 18 - Antianginal Therapy And Lipid-Lowering Agents Flashcards
What is angina pectoris?
Chest pain due to ischemia of heart. Caused by atherosclerosis. Worsens gradually: from stable angina (pain during exertion) to unstable angina (^ severity/during rest).
What are 5 factors that ^ O2 demand?
Preload. Blood pressure. Contractility. Ejection time. HR.
What is another name for preload? What substances increase it and what substances decrease it?
AKA end diastolic volume. Nitrates \/ preload (Dilates the veins). Beta-blockers ^ preload. A mix of two will \/ slightly preload.
What is a good measure of afterload? What substances \/ it?
A good measure of afterload is BP. Nitrates and beta blockers \/ afterload. Combination of the two makes a greater \/.
What does beta-blockers do to contractility? Nitrates? Combination of the two?
Beta-blockers \/. Nitrates ^. Combination causes little change.
What does beta-blockers do to HR? Nitrates? Combination of the two?
Beta-blockers: \/. Nitrates ^. Combination: net \/ (beta-blockers are a little stronger).
What does beta-blockers do to Ejection time? Nitrates? Combination of the two?
Beta-blockers: ^. Nitrates: \/. Combination: no effect.
What does beta-blockers do to Myocardial oxygen deman? Nitrates? Combination of the two?
Beta-blockers: \/. Nitrate: \/. Combination: greater \/.
What are five statins?
Lovastatin. Pravastatin. Simvastatin. Atorvastatin. Rosuvastatin.
What are the effects of Statins?
Inhibit the ability to produce de novo cholesterol. ^ cell surgace LDL receptors. \/ plasma LDL. ^ HDL. \/ triglycerides.
What are the side effects of statins?
Hepatotoxicity. Myalgias. Myositis. Rhabdomyolysis.
What are three Bile acid binding resins? What do they do?
Cholestyramine. Colestipol. Colesevelam. They prevent reabsorption of bile.
What are the side effects of Bile acid binding resins?
Prevent reabsorption of bile. Cause GI problems. \/ absorption of fat soluble vitamins. Rarely lead to development of cholesterol gallstones.
What is a unique use of Cholestyramine?
Will bind Clostridium difficile toxin.
What is Ezetimibe? How does it work?
It is a cholesterol absorption blocker. It prevents cholesterol reabsorption at the small intestine brush border. Side effect: ^ in LFTs.
What is the drug of choice to raise HDL? What are the side effects?
Niacin. Side effects are flushing, rash, itching.
Which type of drugs are the most effective in lowering triglycerides? What are two examples of it?
Fibrates. Two examples are Gemfibrozil and Fenofibrate.
What are adverse effects of Fibrates?
Myositis. Myalgias. Hepatotoxicity. ^ cholesterol gallstones. Take care when combine w/ Statins.
What foods have omega-3 fatty acids? What do they do?
Fish Oil (salmon, halibut, coldwater ocean). Flaxseed oil. It lowers triglycerides.
Which lipid-lowering agent matches the following description: SE of facial flushing.
Niacin.
Which lipid-lowering agent matches the following description: SE of elevated LFTs, myositis.
Statins, fibrates.
Which lipid-lowering agent matches the following description: SE of GI discomfort, bad taste.
Bile acid binding resins.
Which lipid-lowering agent matches the following description: Best effect on HDL.
Niacin.
Which lipid-lowering agent matches the following description: Best effect on triglycerides/VLDL.
Fibrates, omega-3 fatty acids.
Which lipid-lowering agent matches the following description: Best effect on LDL/cholesterol.
Statins.
Which lipid-lowering agent matches the following description: binds C.diff toxin.
Cholestyramine.
A 50 y.o man starts on lipid-lowering medication. Upon his first dose, he develops a rash, pruritus, and diarrhea. What drug is he taking?
Niacin.
How can the flushing reaction of niacin be prevented?
Aspirin or NSAID 30 mins before niacin. Avoid alcohol/hot beverages. Take at bedtime. Be persistent.
Which enzyme do statins inhibit?
HMG-Coenzyme A reductase.
