Lecture 12 - Anti-Anginal Therapies

Question 1

Nitrates and Nitrites relax VSMC –> vasodilation. Which vessels feel the greatest effect?

Answer 1

Veins&raquo_space; Large arteries&raquo_space; Arterioles

Question 2

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).

Answer 2

Aldehyde Dehydrogenase

End Diastolic Volume

Question 3

At high doses, Nitrates/Nitrites dilate arterioles –> decreases systemic BP –> decreases ____load. The combination of venous and arteriolar dilation decreases myocardial oxygen demand.

Answer 3

Afterload

Question 4

Nitrates and Nitrites also increase intracellular c_____, which results in NO production and VSMC relaxation (vessel dilation.)

Answer 4

cGMP

Question 5

______ hypotension, Reflex ______, Skin flushing, and headache are possible side effects of Nitrates/Nitrites.

Answer 5

Orthostatic hypotension

Reflex Tachycardia

Question 6

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.

Answer 6

Phosphodiesterase type 5

Question 7

Propranolol and Metoprolol are both ______ (hydro or lipophilic?), so they can cross the BBB. Thus, they can cause lethargy and depression.

Answer 7

Lipophilic

Question 8

Beta blockers can cause side effects including Bradycardia, _______ (think of where they act in the lungs), fatigue, and sexual dysfunction.

Answer 8

Bronchospasm

Question 9

Ranolazine likely acts by inhibiting the late ____ channel current –> decrease in intracellular _____ –> decrease Ca++ influx –> decrease VSMC contraction.

Answer 9

Na+ channels

Na+