Cardio: Nitrates Flashcards

1
Q

Nitric oxide activates __________ in vascular smooth muscle.

A

guanylyl cyclase

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2
Q

What does increased level of cGMP do inside cells?

A

It decreases intracellular calcium and deactivates myosin-light-chain kinase.(Think of how John Nitro gets to cut the P locks off of his Chain gang, just like how cGMP gets to cut phosphate groups off of myosin and prevent contraction.)

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3
Q

True or false: nitrates primarily affect arteries.

A

False. It affects veins most, but also arteries (just like the blue pants of the prisoners set free by John Nitro).

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4
Q

Nitrates mostly decrease ____-load.

A

pre (because of their effect on veins)

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5
Q

Why are sublingual tablets commonly used for nitroglycerine?

A

Because the liver has a high first-pass metabolism on nitroglycerine, so bypassing it is helpful.

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6
Q

Nitroglycerine has an extremely short half-life, so ___________ are used as maintenance therapies.

A

isosorbide dinitrate and isosorbide mononitrate (large doses)

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7
Q

Although it has not been shown to decrease mortality, nitroglycerine has been shown to help with __________ in acute coronary syndrome.

A

pain and symptom relief

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8
Q

Nitrates should be avoided in what kind of MI?

A

A right-sided MI, because they decrease pre-load; in this case, administer fluids to increase pre-load.

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9
Q

Nitroglycerine can acutely reduce ___________ in the lungs.

A

pulmonary edema (Think of the pump operator with the wet lung spots.)

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10
Q

What is pulmonary edema a possible symptom of?

A

Hypertensive emergency (think of the shutoff valve and how it represents NO shutting off hypertension)

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11
Q

Nitroglycerine can lead to venous dilation that causes blood to pool in the extremities. What cardiac effect does this cause?

A

Reflex tachycardia (just like the doctor with his heart-shaped reflex hammer rushing in to help the fainting woman); beta-blockers can be given to counteract this undesirable effect

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12
Q

What non-cardiac symptoms can nitro cause?

A

Facial flushingThrobbing headachesMethemoglobinemia (Think of the red-faced assistant, his obvious headache signs, and the rusty – oxidized –heme on the cart wheels.)

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13
Q

What is tachyphylaxis?

A

Rapidly decreasing efficacy of a drug

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14
Q

What drug can you not co-administer with nitrates?

A

Sildenafil and other PDE-5 inhibitors

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