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Pharm > Cardio VIII and IX > Flashcards

Cardio VIII and IX Flashcards

1
Q

What happens when there is increased baroreceptor firing?

A

Decreased sympathetic drive and increased parasympathetic tone, resulting in decreases in peripheral resistance, HR, BP

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2
Q

What is the basis for electrically stimulating the baroreceptor?

A

Will decrease sympathetic tone, and increase parsympathetic

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3
Q

What is the MOA of alpha-methyldopa? Is this safe to use in pregnancy? What are the disadvantages to this?

A

Alpha 2 agonist
yes
Short acting

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4
Q

What are 5 drugs that are safe to use to treat HTN in pregnancy?

A 
Alpha-methyldopa
labetalol
Nifedipine
Hydralazine
Metoprolol
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5
Q

What is the MOA of labetalol? is it safe to use in pregnancy?

A

third generation beta blocker (b1=b2>a1>a2)

yes, but short acting

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6
Q

Why is labetalol preferred to use in pregnancy, over other beta blockers?

A

Theoretical beneficial effect of alpha blockage on uteroplacental blood flow

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7
Q

What is the MOA of nifedipine safe to use in pregnancy?

A

CCB

Yes

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8
Q

What is the major drawback/ potential side effect of using hydralazine in pregnancy to treat HTN?

A

Increased risk of maternal hypotension

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9
Q

What is the MOA of metoprolol? Is it safe to use in pregnancy?

A

beta blocker

Yes

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10
Q

What are the three drugs that are generally avoided in treating HTN during pregnancy?

A

Diuretics
Atenolol
Nitroprusside

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11
Q

Why are diuretics avoided when treating HTN in pregnant individuals?

A

May impair pregnancy-associated expansion in plasma volume

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12
Q

Why is atenolol not used to treat HTN in pregnant patients?

A

May impair fetal growth

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13
Q

Why is nitroprusside not used to treat HTN in pregnancy?

A

Risk of fetal CN poisoning

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14
Q

What are the two drugs to treat HTN that are contraindicated in pregnancy?

A

ACE inhibitors

Angiotensin receptor antagonist

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15
Q

Why are ACE inhibitors contraindicated in pregnancy?

A

Multiple fetal abnormalities

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16
Q

Why are angiotensin receptor antagonists contraindicated in pregnancy?

A

Multiple fetal abnormalities

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17
Q

Which ethnicity does not respond well to ACEI?

A

African Americans

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18
Q

What is the first line treatment for HTN with DM? Additional?

A

ACEI or ARB

Thiazide and Beta blockers

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19
Q

Anginal pain is due to the release of what chemicals?

A

Bradykinin

Adenosine

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20
Q

Angina, unstable angina, or acute MI: retrosternal chest pressure/burning, or heaviness that radiates to the jaw/left arm

A

Angina

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21
Q

Angina, unstable angina, or acute MI: precipitated by exercise, cold weather, or emotional stress

A

Angina

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22
Q

Angina, unstable angina, or acute MI: typically

A

unstable angina

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23
Q

Angina, unstable angina, or acute MI: sudden onset, usually lasting >30 minutes, usually associated with SOB, n/v weakness

A

Acute MI

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24
Q

What is the effect of beta blockers on O2 demand of cardiac tissues? How?

A

Decreases via decreased HR, contractility

25
Q

What is the effect of organic nitrates on myocardial O2 demand? How?

A

Decreases via preload and afterload

26
Q

What is the effect of vasodilators on myocardial O2 supply?

A

Increase supply via increased coronary blood flow

27
Q

What is the effect of statins and antithrombotics on oxygen supply of the heart?

A

Increase via increase regional blood flow

28
Q

What is the MOA of NTG?

A

Organic nitrate

29
Q

What is the MOA of isosorbide dinitrate (ISDN)?

A

Organic nitrate

30
Q

What is the MOA of isosorbide mononitrate (ISMN)?

A

Organic nitrate

31
Q

What is the general MOA of nitrates?

A

Prodrugs that must undergo denitrification by mitochondrial aldehyde reductase to yield NO

32
Q

What is the effect of NO on tissues?

A

Activates soluble GC, which increases cGMP, increasing mitochondrial Ca uptake, and decreases Ca influx

33
Q

What is the effect of soluble GC on Ca in cells (2)?

A

Decreases uptake

Increases uptake by mitochondria

34
Q

CP that changes with inspiration is probably what?

A

Not caused by MI

35
Q

CP that is TTP is probably what?

A

Not MI–think costochondritis

36
Q

What is the enzyme in the mitochondria that converts the prodrug of nitrates to NO?

A

Mitochondrial aldehyde reductase

37
Q

What enzyme is phosphorylated when NO is added to cells?

A

MLCK (which inactivates it, and causes vasorelaxation)

38
Q

How long does it take for nitrate tolerance to develop?

A

24 hr period

39
Q

How can you maintain the effect of nitrates, and prevent the tolerance that develops?

A

Using dosing regimens that allow for a nitrate-free time for several hours

40
Q

What are the tissues that metabolize NTG?

A

hepatic

Intravascular

41
Q

What are the two routes by which NTG is given?

42
Q

True or false: there is no evidence for NTG’s efficacy when given orally

43
Q

How is isosorbide dinitrate given? What is the usual dose?

A

PO or SL

QD dosing

44
Q

Which of the nitrates does not undergo a first pass hepatic metabolism?

A

Isosorbide mononitrate

45
Q

Which of the nitrates can be given QD?

A

Isosorbide di and mononitrates

46
Q

What is the major effect of nitrates?

A

Potent vasodilation to decrease ventricular volume and preload

47
Q

What is the effect of nitrates on peripheral vascular resistance?

48
Q

What is the effect of nitrates on the coronary resistance? What is the importance of this?

A

None

No coronary steal

49
Q

What is coronary steal?

A

Vasodilation in one area of the heart leads to decreased blood flow to another area.

50
Q

What is the therapeutic use of SL nitrates?

A

Acute attacks of angina

Prophylactically before doing something that would cause angina

51
Q

What is the therapeutic use of long-acting nitrates?

A

Aginal pain and to increase exercise tolerance

52
Q

What should you do if giving a pt NTG for the first time?

A

Have them lie supine

53
Q

What diseases, besides angina, are nitrates used?

A

acute HF and active ischemia

54
Q

ISDN and what other drug is useful for treating CHF in african americans?

A

Hydralazine

55
Q

Why are nitrates useful in treating CHF?

A

Decreases preload

56
Q

What is the MOA of using nitrates for an MI?

A

Dilation and prevention of constriction of epicardial coronary constriction

57
Q

What are the two side effects of NTG?

A

HA

Hypotension

58
Q

How should you begin ISDN treatment?

A

Titrated up over several days

59
Q

Q waves greater than 1 mm^2 indicates what?

A

Previous MI

Pharm (73 decks)

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