CV & Renal: Anti-Anginal Flashcards

1
Q

Transient Ischemia due to imbalance between O2 Supply & O2 Demand leads to…

A

angina

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2
Q

Classic or variant angina?

Etiology: obstruction of coronary vessels w/ exercise

Tx: Drugs, or CABG or Angioplasty

A

Classic “Angina of Effort”

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3
Q

Classic or variant angina?

Etiology: Spasm/Constriction in atherosclerotic vessels

Tx: Nitrates or CCBs

A

Variant

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4
Q

Ischemia can be relieved by increasing O2 supply or decreasing demand… what is the major mechanism used pharmacologically?

A

decrease demand

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5
Q

Which drugs have the following mechanism?

↑ Endothelial NO →

↑ Guanylyl Cyclase →

↑ cGMP →

↑ Dephosphorylation of Myosin LC →

Relaxation

A

Nitroglycerine and isosorbide dinitrate

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6
Q

Do nitrates and nitrites cause even vasodilation?

A

no, large veins dilated more than arterioles

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7
Q

Nitrates/nitrites are DOC for which kinds of acute angina?

A

classic and variant

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8
Q

Which drug class has the following adverse effects?

Acute Toxicity → Profound Vasodilation → Throbbing headache, hypotension, tachy

Tolerance w/ repeat exposure

A

Nitrates/Nitrites

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9
Q

Describe the kinetics of PO nitrates/nitrites…

A

high first pass

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10
Q

CCBs relax calcium dependent smooth muscle by binding L-type calcium channels, making them good for treating acute or chronic angina?

A

chronic

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11
Q

Which CCB can be formulated as slow release for tx of angina?

A

nifedipine

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12
Q

What adverse effects can nifedipine and dihydropyridines have?

A

Baroreflex mediated ↑ MI development

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13
Q

What adverse effects can Verapamil & Diltiazem have?

A

cardiac depression leading to AV Block, HF, Cardiac Arrest

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14
Q

This drug class exerts the following effects on these tissues:

Heart: ↓ CO
Kidneys: ↓ Renin
CNS: ↓ SNS tone

A

Beta blockers

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15
Q

Do beta blockers directly cause vasodilation?

A

no

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16
Q

Are beta blockers helpful or hurtful in variant angina? why?

A

hurtful

↓ HR & ↑ Ejection time → ↑ LV EDV → ↑ O2 Demand

17
Q

Which drug class has the following adverse effects?

Bronchoconstriction
↑ TGs
↓ insulin & hypoglycemic response
Harmful in variant angina

A

beta blockers

18
Q

Which drug is a partial fatty acid oxidation inhibitor, leading to decreased oxygen consumption and decreased contractility?

A

Ranolazine

19
Q

Which drug has the following therapeutic effects?

↓ LV stiffness, ↑ coronary flow

Drug of last resort

A

Ranolazine

20
Q

Variant angina is treated with what two classes?

A

Nitrates (acute)

CCBs (chronic)

21
Q

What is the most effective combination therapy for angina tx?

A

beta blocker and vasodilator

22
Q

This drug class inhibits cGMP specific PDE5 enzymes, leading to increased cGMP and vasodilation

A

sildenafil

23
Q

What two conditions can sildenafil treat?

A

ED

Pulmonary HTN

24
Q

A patient complains of blue tinged vision and photophobia. Which drug has those SFx?

A

Sildenafil

25
Q

Which drug has the following contraindications?

Pregnant or lactating women or infants/children
If nitrates/nitrites contraindicated
Use w/ alpha blockers → hypotension
Use w/ P3A4 inhibitors
“-ivir”
“-azole”
Cimetidine
“-omycin”
Quinidine/Quinine
Zafirlukast/Zileuton
A

PDE5 Inhibitors

26
Q

Which PDE5 inhibitor achieves maximum concentration within 15 minutes of onset?

A

Vardenafil (levitra)

27
Q

Which PDE5 Inhibitor has a 24-36 hour duration of action?

A

tadalafil (cialis)