CV pharm

Question 1

endo vasodilating molecules (2)

Answer 1

adenosine
bradykinin

argenine -> NO in endothelial cells

Question 2

which drug does “coronary steal” (angina)

Answer 2

dipyridamole (anti plt, selective arteriole dilator): doesn’t dilate collateral ARTERY

c/i: angina

Question 3

mechanism of TOLERANCE dev: nitrates

Answer 3

1. (primary): generation of free radicals (peroxy-nitrate: inhibits gyanylyl cyclase GTP -> cGMP)
   - give Isosorbide DInitrate w/ hydralazine (anti-oxidant)
2. homeostatic neurohumoral mechanisms: baroreceptor reflex, RAA
3. can’t convert to NO b/c vascular smooth muscle depletion of MAD enzyme or sulfhydrl groups (MAD’s cofactor)

Question 4

viagra (sildenafil, tadalafil Cialis) MOA

Answer 4

block PDE which cGMP -> GMP : more vasodilation

nitrate: wait 6hrs to take viagra
can take nitrate 24 hrs after viagra, 48hrs after tadalafil

Question 5

microvascular angina

Answer 5

nitrate + CCB

Question 6

Ranolazine

Answer 6

MOA: block LATE NA+ current -> dec myocyte contraction
only for stable angina
doesn’t change BP or HR
s/e: prolong QT, interaction w/ CYP450

Question 7

s/e of a-methyldopa & clonidine (postsyn a2A receptor in vasomotor center AGONISTS)

Answer 7

dry mouth

sedation

Question 8

Nitroprusside

Answer 8

indication: HT emergency
short-acting, prodrug, doesn’t develop tolerance
dilate both arteries and veins
s/e: release cyanide (excreted by kidneys, c/i to renal pt) -> cyanide toxicity

Question 9

nitrates s/e (4)

Answer 9

reflex tachycardia, hypotension, flushing, headache

Question 10

with atrial arrhythmias, the stasis of blood in the atria increases chance of
clot formation and stroke, so you also need to give an anticoagulant. Keep in mind that
amiodarone inhibits the metabolism of warfarin, so you have to cut dose of warfarin by
1/3 to ½. Also make sure to check for interactions of newer anticoagulants with
amiodarone.

Answer 10

.

Question 11

why is ALDOSTERONE bad?

Answer 11

1. increase Na+/water retention -> edema
2. hypokalemia -> arrhthymia
3. reduce myocardial NE uptake -> remodeling
4. myocardial FIBROSIS
5. reduced baroreceptor sensitivity -> inc SNS -> inc risk of SCD
6. alter Na+ channel expression (like ENac in CD) in heart too

Question 12

does ACEi (Captopril) change HR in HF?

Answer 12

no. doesn’t effect HR

Question 13

ACEi dilates
only ARTERIAL in HT
both A/V in HF (b/c it was already so constricted by high ATII)

Answer 13

.

Question 14

Heparin (indirect) vs. Lepirudin/argatroban/dabigatran (direct thrombin inhibitor)

Answer 14

DTI

1. better at inhibiting FIBRIN-BOUND activated thrombin
2. inhibit activated thrombin-induced plt activation
3. don’t bind nonspecificially to plasma proteins

Question 15

effects of aspirin during preg

Answer 15

give only when ARTERIAL clotting might happen

closure of ductus arteriosus
prolongs labor/bleeding risk during labor