Ischemic heart Disease Drugs Flashcards
(37 cards)
What are the risk factors for coronary heart diseases that are controllable?
Hypertension, high cholesterol, diabetes, smoking cigarettes, obesity
What are the uncontrollable risk factors for CAD?
Age, gender (male), race and family hx
Burning, squeezing or crushing chest pain radiates to the left arm, shoulder or jaw is caused by?
And when does it occur?
Angina pectoris
Occurs mostly after physical exertion
What is seen on the ecg of angina pectoris?
ECG ST segment depression or can be a normal ecg
Chest pain after strenuous physical activity is what class?
1
Chest pain after walking >2 blocks or climbing >1 flight of stairs is what class?
Class 2
Chest pain when walking 1 or 2 blocks or climbing 1 flight of stairs is what class?
Class 3
Chest pain at rest is caused by what class?
Class 4
What is the mechanism of angina pectoris?
Chest pain due to decrease blood and oxygen supply to the heart
Chest pain that occurs with exercise or stress and relieved by rest?
Stable angina
Chest pain that occurs during rest and may progress to MI?
Unstable angina
What causes vasospasm of coronary artery and shows a ST segment elevation during an attack?
How can you differentiate this from an ischemic heart(ex who is at risk)? And how are they treated?
Vasospastic angina (prinzmetal’s angina), because it occurs in females around 40-50. Usually occurs in a younger person. Give nitro prn if it is once a month
What is the goal of treatment of angina and how will it be accomplished?
- To increase blood/ oxygen supply by lowering the vasospasm
- decreasing blood and oxygen demand by decreasing tpr, cardio output or both
Drugs used to treat angina pectoris
Nitrates
Beta blockers
Calcium channel blockers Metabolic modifier Ivabradine
How does the vasodilator nitrates work?
How?
Work by activation of Nitric Oxide (NO)
eNOS(endothelial nitric oxide synthase) can be activated by: Acetylcholine, histamine, bradykinin, and serotonin.
GTP———NO+++ Guanylyl cyclase——————c GMP Relaxation
How? By dephosphorylation of myosin light-chain which prevents its interaction with actin and causes relaxation of the blood vessels which leads to vasodilation.
How Nitrates decreases cardiac oxygen demand?
Dilation of large veins lead to decrease preload and decrease cardia work (decrease oxygen demand)
How Nitrates increase cardiac oxygen supply?
At high doses, nitrates cause arteriolar dilation (aorta) leading to decrease of afterload (increase oxygen supply)
What are Other benefits of Nitrates:
Improve Collateral blood flow, Decrease coronary vasospasm, and Inhibits platelets aggregation
What are the nitrates that are used clinically and how are they given?
Nitroglycerin given sublingual, po, transdermal and iv
Isosorbide given po
What are the side effects of nitric oxide?
Headache, flushing,syncope, reflex tachycardia and edema
A, tachyphlaxis and acute tolerance
What symptom occurs when you give amyloid nitrate? And what treats it?
Methemoglobinemia and methylene blue
What is converted to cyanide and causes cyanide posioning?
Sodium nitroprusside
What are the treatment of cyanide poisoning?
Amyl nitrite or sodium nitrite followed by sodium thisulfate and vitamin b12
Patient on nitrates takes sadenfil or a pde5 inhibitor comes into the ER with chest pains. What is the effect of taking these two?
Severe hypotension
