Ischemic HD Phys/Pharm

Question 1

non selective Beta blockers

Answer 1

propanolol, timolol

Question 1

therapeutic effect Beta blockers

Answer 1

decrease contractility and heart rate > decrease O2 demand

slowing HR can improve ischemic area flow

Question 2

oral availability nitrates

Answer 2

nitroglycerin - high first pass

isosorbide dinitrate - 25%

Question 2

adverse effects and contraindications beta blockers

Answer 2

**Contra: **obstructed airway

acute decompensated heart failrue

marked bradycardia / heart block

caution insulin treated diabetics

**adverse: **fatigue, sexual dysfxn

Question 3

pharmacokinetics Nitrates

Answer 3

nitroglycerin significant first pass

isosorbide dinitrate metabolized to mono

mononitrate not metabolized

Question 4

at __% obstruction, cannot reach maximal flow

at ___% obstruction, distal perfusion pressure cannot maintain normal resting flow

Answer 4

70%

90%

Question 4

B1 selective Beta blockers

Answer 4

metoprolol, atenolol

Question 4

non-dihydropyridine Ca blockers

Answer 4

verapamil, diltizem

Question 4

therapeutic effect nondihydropyridine Ca blockers (verapamil, dilitiazem)

Answer 4

decrease O demand by reducing contractility and HR

(less potent vasodilators than dihydropyridines nifedipine and amlodipine)

Question 6

3 determinents of myocardial O2 demand

Answer 6

Wall stress

HR

contractility

Question 7

electrocardiogram chronic stable angina during ischemia

Answer 7

ST segment depression and T wave inversion

(normalize quickly)

Question 8

Therapeutic effect and mechanism Ranolazine

Answer 8

inhibit late sodium current in myocytes

decreases anginal episodes and increases exercise capacity

Question 10

normal endocardial/epicardial blood flow ratio

Answer 10

1

Question 11

major area of nitrate impact

Answer 11

venous circulation

Question 12

therapeutic effect dihydropyridine Ca channel blockers (nifedipine, amlodipine)

Answer 12

decrease O demand via vasodilation > decrease afterload > decrease wall stress

increase coronary O supply via vasodilation

Question 13

adverse effects Ca blockers

Answer 13

headache flushing

decreased contractility

Bradycardia

edema (esp nifedipine, diltiazem)

constipation (especially verapamil)

Question 14

Unstable angina and MI

Answer 14

plaque rupture > platelet aggregation adn thrombosis > unopposed vasoconstriction

Question 15

silent ischemia

Answer 15

cardiac ischemia without discomfort or pain

Question 17

therapeutic effects of nitrates (not mechanism)

Answer 17

increase venous capacitance (decreasse preload)

small reduction in systemic art pressure (pos reflex tachy+contractility)

Coronary dilator

Question 18

specific indications dihydropyridine Ca blockers (nifedinpine, amlodipine)

Answer 18

relief of vasospasm

Question 19

syndrome X

Answer 19

typical signs of angina with no evidence of atherosclerotic stenoses

Question 20

increase in coronary O2 demand is met via

Answer 20

increases in coronary flow

Question 21

flow is matched with coronary need via ___

Answer 21

autoregulation

Question 22

Q =

Answer 22

P/R

Question 23

nitrates adverse effects

Answer 23

headache

hypotension

reflex tachy

flushing

Question 24

wall stress

Answer 24

Pxr/2h

Question 26

perfusion pressure dependent on ___ prssure

Answer 26

diastolic pressure

Question 27

nitrate drugs

Answer 27

Nitroglycerin

isosorbide mono- **and **dinitrate

Question 28

stable angina

Answer 28

lumen narrowed by plaque

inappropriate vascoconstriction

Question 29

caution should be taken when combining ___

Answer 29

beta blocker and nondihydropyridine Ca blocker (cardiodepression)

Question 30

dihydropyridine Ca channel blockers

Answer 30

Nifedipine, alodipine