MIDTERM 02 - Drugs for IHD and HF Flashcards
1
Q
Refers to circulation within the myocardium
A
Coronary circulation
2
Q
Arteries that branch from the ascending aorta
A
Coronary arteries
3
Q
Veins that drain into the coronary sinus
A
Cardiac veins
4
Q
Condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium
A
Ischemic heart disease (IHD)
5
Q
Heart rate is a determinant of oxygen __________
A
Demand
6
Q
Myocardial contractility is a determinant of oxygen __________
A
Demand
7
Q
Myocardial wall tension/stress is a determinant of oxygen __________
A
Demand
8
Q
Inspired level of oxygen is a determinant of oxygen __________
A
Supply
9
Q
Pulmonary function is a determinant of oxygen __________
A
Supply
10
Q
Hemoglobin concentration and function is a determinant of oxygen __________
A
Supply
11
Q
Level of coronary blood flow is a determinant of oxygen __________
A
Supply
12
Q
Condition that results to reduced blood flow to the myocardium due to the partial obstruction of coronary arteries
A
Myocardial ischemia
13
Q
Refers to chest pain that usually accompanies myocardial ischemia
A
Angina pectoris
14
Q
Condition that results to death of myocardial tissue due to complete obstruction of blood flow of coronary arteries
A
Myocardial infarction (Heart attack)
15
Q
Treatment for myocardial infarction
A
Fibrinolytic
16
Q
An effort-induced/classic angina; caused by transient myocardial ischemia; relieved by rest or NTG (Types of angina)
A
Stable angina pectoris
17
Q
Patients have cardiac disease but without the resulting limitations of physical activity (New York Heart Association functional classification)
A
Class I
18
Q
Patients have cardiac disease resulting in slight limitation of physical activity (New York Heart Association functional classification)
A
Class II
19
Q
Patients have cardiac disease resulting in marked limitation of physical activity (New York Heart Association functional classification)
A
Class III
20
Q
Patients have cardiac disease resulting in inability to carry on any physical activity without discomfort (New York Heart Association functional classification)
A
Class IV
21
Q
Chest discomfort is severe; not relieved by rest or NTG (Types of angina)
A
Unstable angina
22
Q
Variant angina; due to vasospasm; relieved by NTG and CCBs (Types of angina)
A
Prinzmetal’s angina
23
Q
Causes vasodilation and decreased platelet aggregation; used for stable, unstable, and variant angina (Types of anti-anginal drugs)
A
Nitrates
24
Q
A nicotinamide nitrate ester; its MOA is preconditioning by activation of cardiac Katp channels (Examples of nitrates)
A
Nicorandil
25
Relaxes blood vessel smooth muscle and cardiac muscle; used for stable and variant angina (Types of anti-anginal drugs)
Calcium channel blockers (CCBs)
25
Leads to decreased HR and contractility; used for stable and unstable angina (Types of anti-anginal drugs)
β-blockers
26
Used for stable angina when unresponsive to other treatment (Examples of new anti-anginal drugs)
Ranolazine
27
Reduces cardiac rate by inhibiting the hyperpolarization-activated sodium channel in the sinoatrial node (Examples of new anti-anginal drugs)
Ivabradine
28
Is a pFOX inhibitor that partially inhibits the fatty acid oxidation pathway in myocardium (Examples of new anti-anginal drugs)
Trimetazidine
29
Trimetazidine is an example of __________ inhibitor
pFOX
30
The mainstay in management of symptomatic heart failure, especially in edema is present; done through dietary salt restriction and a diuretic
Sodium removal
31
Involves the use of ACEIs, ARBs, Beta blockers, MRAs/Aldosterone antagonists, and ARNI (Treatment principles for heart failure)
Treatment principle I (Neurohumoral modulation)
32
Involves the use of diuretics (Treatment principles for heart failure)
Treatment principle II (Preload reduction)
33
Involves the use of hydralazine-isosorbide dinitrate (Treatment principles for heart failure)
Treatment principle III (Afterload reduction)
34
Involves the use of cardiac glycosides (Treatment principles for heart failure)
Treatment principle IV (Increasing cardiac contractility)
35
Involves the use of Ivabradine (Treatment principles for heart failure)
Treatment principle V (Heart rate reduction)
36
The cornerstone of heart failure therapy (Treatment principles for heart failure)
Treatment principle I (Neurohumoral modulation)
37
The __________ of ACE leads to ↓ angiotensin II and ↑ bradykinin
Inhibition
38
A peptide that contributes to the therapeutic efficacy of ACE inhibitors
Bradykinin
39
ACE inhibitors functions as a __________ by ↓ peripheral resistance and afterload
Vasodilator
40
ACE inhibitors function as an __________ by ↓ water and salt retention and preload
Indirect diuretic
41
ACE inhibitors function as a __________ by ↓ sympathetic activity
Sympatholytic
42
ACE inhibitors helps in __________ by ↓ long-term remodeling of the heart and blood vessels
Antiremodeling
43
The first-line therapy for chronic HF (Drugs under treatment principle I)
ACE inhibitors
44
Used for selective, competitive receptor antagonism at the AT1 receptor (Drugs under treatment principle I)
Angiotensin (AT1) receptor blockers (ARBs)
45
Used as a second choice in HF in patients who do not tolerate ACE inhibitors (Drugs under treatment principle I)
Angiotensin (AT1) receptor blockers (ARBs)
46
Used for competitive inhibition of β receptor (Drugs under treatment principle I)
Beta blockers
47
__________ and __________ are examples of cardioselective β blockers (MB)
Metoprolol, Bisoprolol
48
__________ is an example of nonselective β blocker and an α1 receptor antagonist
Carvedilol
49
__________ is an example of cardioselective β blocker that is an NO-mediated vasodilator
Nebivolol
50
It leads to lower HR and contractility, as well as lower renin levels (Drugs under treatment principle I)
Beta blockers
51
Used for all patients with symptomatic HF and all patients with left ventricular dysfunction after MI (Drugs under treatment principle I)
Beta blockers
52
____________ heart failure can precipitate acute decompensation of cardiac function
New onset/Acutely decompensated
53
Used for antagonism of nuclear receptors of aldosterone (Drugs under treatment principle I)
Mineralocorticoid receptor antagonists (MRAs)/Alodsterone antagonists
54
A selective antagonist of the mineralocorticoid receptor (Examples of MRAs/Aldosterone antagonists)
Eplerenone
55
A nonspecific steroid receptor antagonist w/ similar affinity for progesterone and androgen receptors (Examples of MRAs/Aldosterone antagonists)
Spironolactone
56
Used for K+ sparing diuresis and complete inhibition of aldosterone (Drugs under treatment principle I)
Mineralocorticoid receptor antagonists (MRAs)/Aldosterone antagonists
57
Used for chronic HFrEF; may become the first choice in HF (Drugs under treatment principle I)
Angiotensin receptor/Neprilysin inhibitor (ARNI)
58
Works by increasing Na+ and water excretion; should not be given to patients without congestion (Drugs under treatment principle II)
Diuretics
59
Used for inhibition of NKCC2 in the ascending limb of the Loops of Henle (Examples of diuretics)
Loop diuretics
60
Diuretics of choice in HF (Examples of diuretics)
Loop diuretics
61
Furosemide, Torasemide, and Bumetanide are all examples of __________
Loop diuretics
62
Hydrochlorothiazide (HCTZ) and Chlorthalidone are all examples of __________
Thiazide diuretics
63
Used for inhibition of NCC in the distal convoluted tubule (Examples of diuretics)
Thiazide diuretics
64
Used for inhibition of Na+ entry in ENaC in the apical membrane of collecting tubule (Examples of diuretics)
Potassium-sparing diuretics
65
Amiloride and Triamterene are all examples of __________
Potassium-sparing diuretics
66
Dilates large blood vessels; a venous dilator (Drugs under treatment principle III)
Isosorbide dinitrate (ISDN)
67
Its MOA is unknown; an arteriolar dilator (Drugs under treatment principle III)
Hydralazine
68
Can reduce damaging remodeling of the heart; lowers mortality in African-Americans (Drugs under treatment principle III)
Hydralazine isosorbide dinitrate
69
Known for thousands of years; were used erratically and with variable success until 1785 (Drugs under treatment principle IV)
Cardiac glycosides
70
__________ is sourced from Digitalis lanata (White foxglove)
Digoxin
71
__________ is sourced from Digitalis purpurea (Purple foxglove) and Digitalis lanata
Digitoxin
72
Works by increasing cardiac contractility; used for heart failure, atrial fibrillation, and atrial flutter (Drugs under treatment principle IV)
Cardiac glycosides
73
Most frequent and most serious adverse effect of cardiac glycosides
Cardiac arrhythmias
74
__________ is a strong determinant of cardiac energy consumption
Heart rate (HR)
75
Used for selective inhibition of If sodium channel (Drugs under treatment principle V)
Ivabradine
76
Effective in both systolic and diastolic failure (Treatments for chronic diastolic heart failure)
Nebivolol
77
Used to increase ventricular filling time by decreasing HR (Treatments for chronic diastolic heart failure)
Ivabradine
78
A heterogenous clinical syndrome most often resulting in need for hospitalization
Acute decompensated heart failure
79
__________ treatment is the rule in drug therapy of acute HF
Intravenous (IV)
80
Promptly initiated in dyspnea and signs of fluid overload/congestion (Treatments for acutely decompensated heart failure)
Loop diuretics (Ex: Furosemide IV)
81
Can be added in small doses to loop diuretics to break a relative resistance to loop diuretics (Treatments for acutely decompensated heart failure)
Thiazide diuretics
82
Lowers preload and afterload; no documented symptomatic benefit; best suited for patients with hypertension (Treatments for acutely decompensated heart failure) (NN)
Nitroglycerin, Nitroprusside
83
Dilates arterial and venous blood vessels; approved for the treatment of acutely decompensated heart failure in the US (Treatments for acutely decompensated heart failure)
Nesiritide
84
Agents that are associated with worse outcome; should be restricted to patients with critically low CO and perfusion of vital organs (Treatments for acutely decompensated heart failure)
Positive inotropic agents
85
A selective β1 agonist; increases CO; provides the strongest stimulation of the heart; a catecholamine (Treatments for acutely decompensated heart failure)
Dobutamine
86
β agonist of choice in acute HF with systolic dysfunction; a catecholamine (Treatments for acutely decompensated heart failure)
Dobutamine
87
A balanced β1, β2, and α1 adrenergic agonist; is the second-choice inotrope in acutely decompensated heart failure; a catecholamine (Treatments for acutely decompensated heart failure)
Epinephrine
88
Potent β1 and α1 agonist and weak β2 receptor agonist; has positive inotropism; a catecholamine (Treatments for acutely decompensated heart failure)
Norepinephrine
89
Used for inhibition of PDE-3 and PDE-4; increases contractility, HR, and CO; a phosphodiesterase inhibitor (Treatments for acutely decompensated heart failure)
Milrinone
90
A short term treatment of acute HF and advance/severe chronic HF; a phosphodiesterase inhibitor (Treatments for acutely decompensated heart failure)
Milrinone
91
Withdrawn in the USA; its MOA is the same as milrinone; a phosphodiesterase inhibitor (Treatments for acutely decompensated heart failure)
Inamrinone
92
Used for relative selection inhibition of PDE-3; a phosphodiesterase inhibitor (Treatments for acutely decompensated heart failure)
Enoximone
93
Works by binding to and inducing conformational change in troponin C; causes vasodilation; a short-term treatment (Treatments for acutely decompensated heart failure)
Myofilament calcium sensitizers
94
A recombinant human relaxin 2; a promising drug for ADHF (Novel approaches to HF)
Serelaxin
95
A direct, heme-dependent stimulator of sGC (Examples of sGC activators)
Riociguat
96
A heme-dependent activator of sGC (Examples of sGC activators)
Cinaciguat
97
The oxidative inactivation of __________ is believed to be a common pathology in cardiovascular disease
Soluble guanyl cyclase (sGC)
98
Are sodium-glucose cotransporter-2 (SGLT2) inhibitors (Novel approaches to HF) (DE)
Dapagliflozin, Empagliflozin
99
A PDE-5 inhibitor; improves filling pressures and right ventricular function in HFpEF (Novel approaches to HF)
Sildenafil
100
No improvement in QOL or submaximal exercise capacity and decreased overall activity levels (Novel approaches to HF) (II)
Isosorbite mononitrate, Inorganic nitrates
102
Drug that promotes inhibition of neprilysin (Examples of angiotensin receptor/neprilysin inhibitor)
Sacubitril
103
A peptidase mediating the enzymatic degradation and inactivation of natriuretic peptides, bradykinin, and substance P
Neprilysin
104
Levosimendan and pimobendan are examples of __________ (Treatments for acutely decompensated heart failure)
Myofilament calcium sensitizers
