Lecture 49 Flashcards
What is the treatment for stable angina? What is stable angina
Stable angina occurs during exercise
Decreasing the sympathetic drive (BB) –> decreasing preload
Nitrates –> decrease afterload
Organic Nitrates MOA
- give a nitrate –> bio-activated –>. increase nitric oxide –> activate guanylate cyclase –> cGMP –> smooth muscle relaxation
Nitrates
vasodilate the veins –> store more blood and vasodilate the veins –> more storage –> decreases the preload
What are the effects of the nitrates?
Orthostatic hypotension, fainting, headaches, dizziness, facial flushing, reflex tachycardia
SE:
Orthostatic hypotension, fainting, headaches, dizziness, facial flushing, reflex tachycardia
Nitroglycerin
Sublingual or nasal spray to relieve angina–> emergency drug in heart attack
What are the prophylactic nitrates, and what are the dosing?
Isosorbide di-nitrate: given multiple times per day
Isosorbide Mononitrate: given once per day
What are the nitrate free periods?
When nitrate free periods are given in between in order to prevent tolerance
What nitro-prusside
direct NO donor, no bio-activation, therefore you not develop tolerance
What is nitroglycerin contraindicated in?
PDE5 inhibitors aka sildenafil aka viagra
What does coronary steal mean?
it means that vasodilate the healthy vessels more than clogged vessels, so more blood routed to healthy vessels –> even less blood goes to places supplied by the clogged vessels
What are the beta blockers function?
Decreases sympathetic drive of the heart
B1 speeds up the heart, M2 slow down the heart
M2 slows down the heart
Non-selective (B1 and B2): propanolol, nadolol, pindolol
Calcium Channel blockers
Dihydropiridines:
L type Ca channels in arterial smooth muscle –> doesn’t affect smooth muscle –> types
What is amlodipine great for?
vasospastic
Nefidipine
only extended release for angina and hypertension –.> great for vasospastic
