Exam 1: Ischemia and CAS Flashcards

1
Q

What type of angina is considered “Demand Ischemia”

A

Stable

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2
Q

What are the characteristics of Stable Angina

A

occurs upon exertion
improves with rest
chronic yet stable coronary obstruction

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3
Q

What are goals for the treatment of chronic/variant angina

A

dilate coronary arteries ( decrease afterload)
Decrease O2 demand
Decrease preload

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4
Q

What does dilating coronary arteries do?

A

Decrease afterload “A”

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5
Q

what does dilating veins do?

A

Decrease preload

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6
Q

How do nitrates work?

A

Act on GC to increase cGMP to dephosphorylate MLC and cause venous relaxtion

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7
Q

What do nitrates do to cGMP

A

Increase it

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8
Q

Which drug acts on GC

A

nitrates

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9
Q

How do CCBs work?

A

block L-type channels to prevent calcium influx that would otherwise activate calmodulin and cause contraction

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10
Q

Which drug prevents the activation of calmodulin?

A

CCBs! (C)

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11
Q

How do Beta blockers work?

A

they prevent the stimulation of the myocardium by epinephrine by preventing the release of calcium from the SR

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12
Q

What is the target of CCBs and why? (veins or arteries)

A

Arteries! They lack the SR calcium stores that veins have making the CCB effective

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13
Q

What state of the heart are cardiac cells able to be better perfused? (systole or diastole)

A

Diastole

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14
Q

What does the decreased heart rate during exertion allow beta blockers to do?

A

prolong diastole

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15
Q

what does ivabradine do?

A

prolong diastole and improve ventricular filling

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16
Q

What is the goal of treating unstable angina

A

block thrombus formation (prophylaxis)

dissolve existing thrombus

17
Q

What does aspirin do?

A

Inactivates COX-1 to prevent TXA2 synthesis, preventing platelet aggregation

18
Q

What does heparin do?

A

binds to antithrombin to activate and propagate its effect of inactivating clotting factors

19
Q

How do P2Y12 antagonists work?

A

by irreversibly inhibiting P2Y12 to prevent Gp activation it prevents platelet aggregation

20
Q

Which drug classes causes reflex tachycardia?

A

nitrates and CCBs

21
Q

Which drug class prevents reflex tachycardia

A

beta-blockers (cause they slow HR)

22
Q

which drug class increases preload?

A

beta-blockers

23
Q

which drug class blocks increased preload?

A

nitrates! (circle of life baby)

24
Q

How does nitrate tolerance occur?

A

The inactivation of ALDH2 is what allows NTG to breakdown in to NO in the mitochondria but it there’s a limited supply so it needs time to re-synthesize

25
Q

What are late Na channels and why do they matter?

A

They try to respond to the low supply of ATP caused by low oxygen in ischemia by opening to fill the cells with Na and prolong depolarization time. This causes a retention of calcium in the cell which means less oxygen can get in and etc. etc. it’s bad

26
Q

What drug blocks late Na channels?

A

Ranolazine! (replexa)

27
Q

What is dosing of Replexa?

A

500 - 1000mg bid

28
Q

what’s the best prophylaxis treatment of unstable angina

A

aspirin and clopidogrel, STOP THAT CLOT