Cardio-Ischemic Cardiac Diease

Question 1

What drug class is amlodipine

Answer 1

Noncardioactive calcium channel blocker

Question 2

What is the mechanism of action for ranolazine

Answer 2

INhibits the late sodium current in cardiomyocytes

Question 3

What is the the drug class for dipyridamole

Answer 3

Arterial vasodilator

Question 4

What is the result of ranolazine

Answer 4

• Reduces diastolic tension and compression of coronary vessels in diastole
• Reduces Cardiac contractility and oxygen demand
• Does not affect HR, coronary blood flow

Question 5

What are the undesired effects of beta blockers or calcium blockers alone

Answer 5

Increase in EDV and ejection time

Question 6

What are the undesired effects of nitrates alone

Answer 6

Increased HR and contractility via baroreceptor reflex

Question 7

What drug class is isosorbide mononitrate

Answer 7

Nitrates aka vasodilators

Question 8

What are the clinical adverse effects of nitrates

Answer 8

• Headache (meningeal vasodilation)
• Orthostatic hypotension
• Sympathetic discharge
• Water and salt reabsorption

Question 9

What is the mechanism of action for nitrates

Answer 9

1) Nitrates are metabolized to act as donor Nitric oxide
2) Nitric oxide binds to Guanylyl cyclase
3) GTP —> cGMP
4) Potassium channel opens, causing hyperpolarization
5) Hyperpolarization causes decreased calcium entry and subsequent contraction of vasculature

Question 10

What are the contraindications for beta blockers

Answer 10

• Asthma
• Peripheral vascular disease
• type 1 diabetics
• AV conduction abnormalities

Question 11

Which patients are nitrates contraindicated

Answer 11

Elevated intracranial pressure

Question 12

Which drugs will interact with nitrates

Answer 12

Those used for treatment of ED, which are the -afils

Question 13

What is the mechanism that calcium channel blockers work for angina

Answer 13

Decreased myocardial O2 demand: (atherosclerotic angina)
-Decreased peripheral resistance and afteload and BP
-Arteries more affected than veins
-Decreased cardiac contractility and heart rate (in cardioactive blockers)
Increased blood supply: (variant angina)
-Lilation of coronary arteries relieves the spasms

Question 14

What drug class is Nicardipine

Answer 14

Noncardioactive calcium channel blocker

Question 15

What drug class is diltiazem

Answer 15

cardioactive calcium channel blocker

Question 16

What is the order of vasculature affected by nitrates

Answer 16

Veins> large arteries > small arteries and arterioles

Question 17

What is the result of combined nitrates and beta blockers

Answer 17

• Decrease in the HR and Atrial pressure

- No change in the EDV, contractility, or ejection time

Question 18

What is the long acting noncardiactive calcium channel blocker

Answer 18

Amlodipine (half life of 30-50 hours)

Question 19

What are the adverse effects of nitrate use

Answer 19

Development of tolerance leading to:

• Depletion of thiols
• Increased superoxide radicals and decrease in NO
• Activation of SNS
• Retention of salt and water

Question 20

What is the treatment in the cause of vasospastic angina

Answer 20

Vasodilators

Question 21

What drug class is verapamil

Answer 21

cardioactive calcium channel blocker

Question 22

What drug class is nitroglycerin

Answer 22

Nitrates aka vasodilators

Question 23

What drug class is isosrbide dinitrate

Answer 23

Nitrates aka vasodilators

Question 24

What drug class is Nifedipine

Answer 24

Noncardioactive calcium channel blocker

Question 25

What are the clinical situations that nitrates are used

Answer 25

• Short acting formulas for angina attack

- Long acting formulas for prevention of attack

Question 26

What is the mechanisms utilized by nitrates during angina

Answer 26

• Overall, decreases the myocardial oxygen demand
• Dilation of veins (main effect by increased venous capacity, reduced preload)
• Dilation of arterioles, but no substantial increased blood flow to ischemic area

Question 27

What are the adverse effects of beta blockers

Answer 27

• Decreased liver glucose mobilization
• Increased VLDL and decreased HDL
• Sedation and depression

Question 28

What is the mechanism that beta blockers are successful in treating angina

Answer 28

reduction in myocardial oxygen demand via:

• Decreased blood pressure and afterload
• Decreased heart rate
• Decreased contractility

Question 29

What are the secondary effects of NO

Answer 29

Blocks:

• LDL oxidation
• Superoxide radicals
• Smooth muscle proliferation
• Monocytes adhesion
• platelet aggregation

Question 30

What is the mechanism that endothelium can relax the vasculature

Answer 30

Release of endothelium derived relaxing factor (EDRF) by ACh

Question 31

What type of angina do calcium blocker act and what is the mechanism

Answer 31

Atherosclerotic angina by decreasing the myocardial Oxygen demand

Question 32

What are the pharmacokinetics of nitrates

Answer 32

• High first pass metabolism due to nitrate reductase in liver
• Isosorbide mononitrate is poor substrate of nitrate reductase and increases bioavailability

Question 33

What are the adverse effects of calcium channel blockers

Answer 33

• Cardia depression, arrest, acute cardiac failure
• Bradycharia and heart block
• reflex Sympathetic activation

Question 34

Which patients or conditions are the used of vasodilators not usedful or helpful and what is the reasoning

Answer 34

Atherosclerotic angina aka classical angina
*Because “coronary steal” where the non-occluded vessel will dilate, so the ischemic area will receive less blood low and the normal will receive more than normal

Question 35

Which drug increases the risk of an MI and in which patients

Answer 35

Fast release Nifedipine increases the risk of MI on a pt with hypertension (medium and slow release are better tolerated)