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Pharm exam 5 > MI drugs > Flashcards

MI drugs Flashcards

1
Q

what causes stable angine

A

due to coronary atherosclerotic occlusion

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2
Q

what causes Vasospastic/variant/Prinzmetal angina

A

due to reversible reduction in coronary blood flow

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3
Q

anginal pain is usually due to release of what?

A

release of bradykinin and adenosine onto nociceptive afferents

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4
Q

duration for acute MI

A

sudden onset, last >/=30 min

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5
Q

duration of rest or unstable angina

A

<20 min

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6
Q

duration of angina

A

2-10 min

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7
Q

organic nitrates for MI

A

Nitroglycerin (GTN), Isosorbide Dinitrate (ISDN), Isosorbide Mononitrate (ISMN)

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8
Q

MOA of organic nitrates

A

Organic nitrates are prodrugs that must undergo denitrification by mitochondrial aldehyde reductase to yield NO

NO activates soluble GC, increasing cGMP –> cGK-1 activation:

  • increase mitochondrial Ca2+ uptake
  • decrease Ca2+ influx
  • Phosphorylates MLCK

–> vasorelaxation

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9
Q

explain nitrate tolerance

A

When given acutely, nitrates have potent hemodynamic and therapeutic effects. However, these effects were lost rapidly during sustained therapy, almost completely when significant plasma concentrations are present throughout the 24-hr period. Tolerance develops early, and cannot be overcome with higher doses

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10
Q

how can nitrate effects be maintained (avoiding tolerance)

A

Nitrate effects could be maintained using dosing regimens that allow for a nitrate-free or low-nitrate concentration for several hours each day.

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11
Q

what nitrate undergoes hepatic and intravascular metabolism

A

Nitroglycerin

  • fast acting
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12
Q

Nitroglycerin is very effective when given via what route

A

sublingual or transdermal

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13
Q

what forms of isosorbide dinitrate are available

A

Available in phasic, sustained release form –> QD dosing –> avoid tolerance

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14
Q

which nitrate does not undergo first pass hepatic metabolism – completely available

A

isosorbide mononitrate

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15
Q

what forms of isosorbide mononitrate are available

A

Available in sustained, phasic release form –> QD dosing –> avoid tolerance

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16
Q

Pharmacodynamic effects of nitrates:

Potent vasodilation in veins –> decrease ventricular volume and 1

No effect on 2.

Little or no effect on the 3 vessels –> avoid 4

A
  1. preload
  2. peripheral vascular resistance
  3. coronary resistance
  4. coronary steal
17
Q

form of nitration that is used for classic therapy for the treatment of acute attacks of angina

A

Sublingual nitrates

18
Q

what nitrates can be prescribed as a prophylactic therapy, taken before activity that would generally lead to angina

A

Nitroglycerin

Isosorbide dinatrate (ISDN)

19
Q

what are long-acting nitrates effective in?

A

angina,

increase exercise duration,

decrease anginal frequency

20
Q

how should dosing be done for long-acting nitrates?

A

Due to nitrate tolerance, dosing must allow for a low or nitrate-free period during the day

21
Q

In acute HF and active ischemia, _____ can be the therapy of choice.

A

organic nitrates

22
Q

good in African-Americans with CHF, especially CHF that results from systolic dysfunction.

A

Isosorbide dinitrate and hydralazine combo

23
Q

what nitrate is often used for Unstable angina and acute myocardial infarction (MI)

A

Sublingual GTN is often used, but intravenous (IV) and transdermal formulations also have a role.

24
Q

SE of nitrates

A

Headaches - most pronounced early aftern initiation

Hypotension - more common with rapid onset

25
Q

what nitrate should be up-titrated over several days to avoid hypotension)

A

Isosorbide dinatrate

26
Q

therapeutic use of ranolazine

A

angina

27
Q

SE of ranolazine

A

Prolongs the QT interval in patients with coronary artery disease (but shortens it in patients with long QT syndrome, LQT3).

***Has not been associated with torsades de pointes

28
Q

MOA of ranolazine

A

Inhibits late sodium current (INaL) that facilitates Ca2+ entry via the NCX –> decrease intracellular Ca2+ –> decrease diastolic tension, cardiac contractility.

29
Q

funny current blocker for MI

A

Ivabradine

30
Q

MOA of ivabradine

A
  • **specific inhibition of If channel –> prolongs phase 4 AP.
  • -> decrease spontaneous firing rate of SA pacemaker cells

***NO negative inotropic effects

No effect on ventilation in COPD patients

31
Q

clinical use of ivabradine

A

Chronic stable angina in pts who cannot take beta blockers

32
Q

SE of ivabradine

A

Luminous phenomenon

  • sensation of enhanced brightness
  • due to Ih blockade in retina

Pharm exam 5 (9 decks)

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