Lecture 10 Cardiac Ischemia Drugs

Question 1

angina pectoris is the result of the build up of ____ in the heart as a result of inadequate ____ ____ ____

Answer 1

metabolites;

coronary blood flow

Question 2

preload is characterised by the left ventricular ____ _____ pressure. decreased by dilation of ____. this causes a decrease in ____ ____ and an increase in myocardial _____

Answer 2

end diastolic, veins; oxygen consumption;

blood flow

Question 3

afterload is characterized by the force distributed in the ventricular wall during ____. It is decreased by dilation of _____, which leads to a decrease in oxygen consumption

Answer 3

systole;

arteries

Question 4

there is little to no flow through the coronaries during _____

Answer 4

systole

Question 5

myocardial oxygen demand is estimated by the double product of ____ * ____

Answer 5

heart rate, systolic bp

Question 6

beta blockers effect the heart by causing a decrease in ____ and _____ = decrease ___ ____ of the heart

Answer 6

heart rate, contractility; oxygen demand

Question 7

organic nitrates and calcium channel blockers decrease both ____ and ____

Answer 7

preload, afterload

Question 8

_____ such as calcium channel blockers increase _____ blood flow, increasing O2 _____

Answer 8

vasodilators;

coronary, supply

Question 9

stable angina is typically due to _____. Angina increases with increased ____ _____

Answer 9

atherosclerosis;

physical exertion

Question 10

variant/prinzmetal’s angina is caused by sudden _____ of large coronary arteries. It can occur at ____ and often occurs at ____

Answer 10

constriction;

rest, night

Question 11

____ angina is often the first warning of impending MI. It is caused by ____ secondary to atherosclerotic plaque ____

Answer 11

unstable;

thrombosis, rupture

Question 12

the goal of treatment of angina is to ____ coronary arteries and increase ____ and/or to decrease myocardial ____ ____

Answer 12

dilate;
perfusion

oxygen demand

Question 13

organic nitrates preferential dilate ____. There is some dilation of ____, especially ____ _____

Answer 13

veins;

arteries, coronary arteries

Question 14

3 main drug classes used in treatment of angina:

Answer 14

organic nitrates, calcium channel blockers, beta blockers

Question 15

calcium channel blockers preferentially dilate _____, causing a decrease in _____

Answer 15

arteries, afterload

Question 16

chromotropic affects:
beta blockers block ____ channels (aka the _____ current). this causes a decreased rate of phase ____, making it harder to reach “_____”

Answer 16

HCN, aka funny current

4 depolarization, threshold

Question 17

besides beta 1 stimulation, what metabolic state increases the rate of depolarization of SA/AV nodes?

Answer 17

acidosis (highlighted in red in notes)

Question 18

_____ is a selective blocker of the HCN channel. this reduces _____. it is off label in the US

Answer 18

ivabradine;

HR

Question 19

inotropic affects:

beta 1 activation causes phosophorylation of ___ channels. this causes an influx of ____ and an increase in _____

Answer 19

CalciumV1.2;
calcium,
contractility

Question 20

_____ and _____ are a particularly good combo for treating stable angina

Answer 20

organic nitrates, beta blockers

Question 21

calcium channel blockers (specifically _____) and ______ have been effective in treating refractory stable angina

Answer 21

DHPs, beta blockers

Question 22

combination of calcium channel blockers and organic nitrates is contraindicated in angina associated with ______. It is effective in treatment of ______ or _____ angina

Answer 22

heart failure;

severe vasospastic or stable

Question 23

most important side effects of beta blockers (3)

Answer 23

bradycardia, AV block, bronchoconstriction

Question 24

____ and ____ especially may cause hypotension, flushing, and headaches

Answer 24

nitrates, DHPs

Question 25

_____ has been known to cause bradycardia, AV block, and constipation

Answer 25

verapamil

Question 26

_____ inhibits the late sodium current

Answer 26

ranolazine

Question 27

ischemia causes low ____, low ____, and inhibits the ____. this cause overload of ____

Answer 27

ATP (Na/K ATPase), pH, late Na channel; overload of Na

Question 28

overload of Na causes a decrease in the effectiveness of _____ exchanger, causing a buildup of ____ in the cell : Heart probs ie increased oxygen demand, arrhythmias,

Answer 28

Na/Ca; calcium

Question 29

ranolazine is used in _____ of angina. the most common side effect is _____, but what is its most important side effect?

Answer 29

prevention; dizziness; prolonged QT

Question 30

3 factors that lead to plaque instability:

Answer 30

large lipid pool, thin fibrous cap, inflammation

Question 31

unstable angina: _____ partially blocks platelet activation; ____ inhibits thrombin formation; _____ antagonists block platelet aggregation

Answer 31

aspirin, heparin, Gp IIb/IIIa receptor

Question 32

drugs used in stents: _____ is a macrolide that binds FKBP12 and inhibits mTOR, preventing cell cycle progression. _____ binds microtubules and stabilizes polymerization. both drugs prevent ____ by inhibiting smooth muscle proliferation

Answer 32

sirolimus, paclitaxel restenosis