Lecture 12 - Anti-Anginal Therapies Flashcards
Nitrates and Nitrites relax VSMC –> vasodilation. Which vessels feel the greatest effect?
Veins»_space; Large arteries»_space; Arterioles
Nitroglycerin is metabolized by mitochondrial ______ _______, releasing NO. Dilation of veins causes pooling of blood in large veins –> less venous return to the heart –> decrease in _____ _____ volume (effectively decreases Pre-load).
Aldehyde Dehydrogenase
End Diastolic Volume
At high doses, Nitrates/Nitrites dilate arterioles –> decreases systemic BP –> decreases ____load. The combination of venous and arteriolar dilation decreases myocardial oxygen demand.
Afterload
Nitrates and Nitrites also increase intracellular c_____, which results in NO production and VSMC relaxation (vessel dilation.)
cGMP
______ hypotension, Reflex ______, Skin flushing, and headache are possible side effects of Nitrates/Nitrites.
Orthostatic hypotension
Reflex Tachycardia
Sildenafil inhibits _________ type 5, so there’s less breakdown of cGMP –> more NO production. Because Nitrates do the same, so these patients should NOT take them for risk of Hypotension.
Phosphodiesterase type 5
Propranolol and Metoprolol are both ______ (hydro or lipophilic?), so they can cross the BBB. Thus, they can cause lethargy and depression.
Lipophilic
Beta blockers can cause side effects including Bradycardia, _______ (think of where they act in the lungs), fatigue, and sexual dysfunction.
Bronchospasm
Ranolazine likely acts by inhibiting the late ____ channel current –> decrease in intracellular _____ –> decrease Ca++ influx –> decrease VSMC contraction.
Na+ channels
Na+