Cardio and Renal 3 Flashcards
Coronary Artery Disease (CAD): Risk Factors - Controllable
Controllable = Modifiable = I can treat
- HTN
- High Cholesterol
- DM
- Cigarette Smoking
- Obesity
CAD: Risk Factors - Uncontrollable
Uncontrollable = I can’t do anything about
- Age
- Gender (Male)
- Race
- Family History (Heredity)
Angina Pectoris: Defined and Characteristics (4)
- Burning, squeezing, or crushing chest pain that radiates to the left arm, shoulder, or jaw
- Mostly after physical exertion
- Emotional excitement, exposure to cold or heavy meal
- **Depressed ST segment
Angina Pectoris: Classification
Class I: Chest pain after strenous physical activity
Class II: Chest pain when walking > 2 blocks OR climbing > 1 flight of stairs
Class III: Chest pain when walking 1 to 2 blocks or climbing 1 flight of stairs
Class IV: Chest pain at rest
Angina Pectoris: MOA
Chest pain due to decrease blood and oxygen supply to the heart
Angina Pectoris: Types (3)
- Stable - Occurs with exercise or stress; relieved by rest
- Unstable - Occurs during rest and may progress to MI
- Vasospastic (Prinzmetal’s angina) - Due to vasospasm of coronary artery
Anti-anginal Drugs: Goal (2)
- Increase blood/oxygen supply by decreasing vasospasm
2. Decrease blood/oxygen demand by decreasing TPR, CO, or both
Anti-anginal Drugs: Drug Types (4)
- Vasodilators
- Beta Blockers
- CCBs
- Metabolic Modifier
Anti-anginal Drugs: Vasodilators - Nitrates: Buzzword
Buzzword: Activation of Nitric Oxide (NO)
endothelial NO synthase can be activated by: ACh, histamine, bradykinin, and serotonin
Anti-anginal Drugs: Vasodilators - Nitrates: MOA
GTP to cGMP via guanylyl cyclase –> Relaxation…
By dephosphorylation of myosin light chain, which prevents its interaction with actin, leading to relaxation and ultimately vasodilation
How do Nitrates decrease cardiac oxygen demand?
Dilation of large veins lead to decrease preload and decrease cardiac work (decrease oxygen demand)
How do Nitrates increase cardiac oxygen supply?
At high doses, nitrates cause arteriolar dilation (Aorta), causing decrease of afterload (increase oxygen supply)
Anti-anginal Drugs: Vasodilators - Nitrates: Other Actions (3)
- Improve collateral blood flow
- Decrease coronary vasospasm
- Inhibit platelets aggregation
Nitrates: Drugs
- Nitroglycerin - Sublingual, PO, transdermal, and IV forms
- Isosorbide: PO and extended relase (constant mild chest pain)
Nitrates: Side Effects
- Headache, flushing, and syncope
- Reflex Tachycardia and edema
- Tachyphylaxis that require rest of >12 hours (drug isn’t as sensitive as it used to be)
- *Methemoglobinemia (with amyl nitrate) –> antidote is methylene blue
Cyanide Poisoning Antidote
Cyanomethemoglobin is reconverted to methemoglobin by rx with Sodium thiosulfate –> thiocyanate ion (less toxic)
Antidote is Amyl Nitrate
Cyanide ions inhibit Compex IV of the ETC; Amyl nitrate forms methemoglobin that bins to CN- ions to form #cyanomethemoglobin
Cyanide Poisoning Antidote: Drug Interactions
Ask patient at the ER if they are taking Sildenafil, it’s a deadly combo due to severe hypotension
Anti-anginal Drugs: Beta Blockers
Atenolol, Metoprolo, Nadolol, Propranolol
Act directly on heart and no direct effect on blood vessels
Anti-anginal Drugs: Beta Blockers MOA
Decrease force of contraction, HR, and CO –> decrease oxygen demand
Anti-anginal Drugs: Beta Blockers - Cautions
With Prinzmetal’s Angina –> BBs keep alpha 1 open, causing vasospasm
Anti-anginal Drugs: Beta Blocker That’s Shown Similar Effect to Nitrate
Carvedilol, because it’s an alpha and beta blocker
Anti-anginal Drugs: CCBs
Dihydroperidine: Amlodipine, Nifedipine
Non-hydroperidine: Verapamil and Diltiazem
Anti-anginal Drugs: CCBs Buzzword
Bepridil (FDA Approved for Angina)
Dilates coronary arteries
Blocks Na and K channels
**If it blocks K channel at risk for —–> Torsades de Pointes
Anti-anginal Drugs: Metabolic Modifier
Ranolazine
Acts by modifying myocardial metabolism
Improves cardiac diastolic function by limiting sodium influx
