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SPR2015_WEEK4 > Nitrates and Calcium Channel Blockers > Flashcards

Nitrates and Calcium Channel Blockers Flashcards

1
Q

Stable Angina

A

fixed, stable obstruction

myocardial ischemia induced by increased exercise

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2
Q

Define variant or prinzmetal angina

A

vasospasm of coronary arteries

sx at rest not exercise

transient ST elev

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3
Q

Define unstable angina

A

increased freq, duration, intensity of angina with less exertion or at rest

high chance of MI

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4
Q

Regulating myocardial O2 supply

metabolic regul

A

1) metab stress
2) decr ATP syntheiis –> produce adenosine
3) adenosine vasodilate and incr coronary flow

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5
Q

Regulating myocardial O2 supply

humoral factors

A

incr risk of thrombus +/- vasospasm

Ach, angiotensin, bradykinin, NO

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6
Q

Regulating myocardial O2 supply

mechanical factors

A

coronary arteries perfused during diastole –> duration (HR) regulates

incr preload or LVEDP, incr ventricle pressure, decr perfusion

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7
Q

factors that affect myocardial O2 demand

A

1) HR
2) wall tension
3) inotropic state

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8
Q

what do nitrates do?

A

relax smooth muscle

vasodilator

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9
Q

mechanism of nitrates

A

NO donors

1) NO stim guanylyl cyclase
2) incr cGMP
3) activ PKG
4) decr cyto Ca2+ –> relaxation and vasodilation

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10
Q

what does vasodilation do?

A

1) decr preload (incr perfusion)
2) decr afterload
3) dilation of epicardial vessels

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11
Q

where is vasodilation most effective?

A

venous side

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12
Q

how can your myocardial cells be tolerant to nitrates

A

depletion of -SH required for NO formation

–> thus dose eccentrically

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13
Q

what is the secondary effect of nitrates

A

antithrombotic

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14
Q

when do you use nitroglycerin

A

acute angina

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15
Q

time of action for nitroglycerin

A

30sec -5 min

lasts 30 min

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16
Q

side effects of nitroglycerin

A

1) HA
2) hypotension
3) reflex tachycardia
4) paradoxical bradycardia

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17
Q

describe isosorbide dinitrate

A

sublingual and orally available

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18
Q

describe isosorbide-5-mononitrate

A

once a day dosing (prevent tolerance)

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19
Q

mechanism of beta blockers

A

binds to b1 receptors in heart and b2 receptors in smooth muscle

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20
Q

effect of beta blockers on heart

A

1) decr HR
2) decr contractility
3) incr diastolic filling, incr perfusion
4) decr wall stress, decr O2 demand

21
Q

what are cardioselective beta blockers

A

preferentially target b1 b/c targeting b2 causes decr vasodilation and bronchodilation

22
Q

describe type of beta blocker

propanolol

A

targets b1 and b2

no intrinsic SA activity

23
Q

effect of propanolol

A

1) decr contractility
2) decr resting and exercising HR
3) decr resting BP
4) anti-arrhythmic (decr AV conduction)

24
Q

when is propanolol contraindicated

A

pts with LV dysfunction

25
Q

side effects of propanolol

A

1) bradycardia
2) AV block
3) decr LV function
4) bronchoconstriction
5) fatigue
6) intensify insulin-induced hypoglycemia

26
Q

describe type of beta blocker

metoprolol

A

highly b1 selective

no intrinsic SA

27
Q

effect of metoprolol

A

1) used in mild to mod CHF
2) decr resting and exercise HR
3) decr contractility
4) decr resting BP
5) decr AV conduction
6) anti-arrhythmic

28
Q

describe type of beta blocker

labetalol

A

nonselective B blocker + a1 blocking ability

slightly ISA

29
Q

effect of labetalol

A

1) decr contractility
2) decr resting BP
3) decr AV conduction
4) anti-arrhythmic
5) vasodilatory

30
Q

caution giving beta blockers in which patients

A

some pts with CAD also have CHF and on digoxin (also AV blocker)

31
Q

effect of calcium channel blockers

A

block L-type Ca2+ channels

32
Q

symptom effect of calcium channel blockers

A

1) decr HR
2) decr contractility
3) decr peripheral vascular resistance and BP

33
Q

where is calcium channel blockers most effective

A

arterial side

34
Q

what is nifedipine

A

dihydropyridine Ca2+ channel blocker

35
Q

describe dihydropyridines 1st gen

nifedipine

A

1) vasodilators
2) decr contractility
3) decr AV node conduction
4) decr HR

36
Q

side effects of dihydropyridines 1st gen

nifedipine

A

1) hypotension –> reflex tachycardia

2) contraindicated for LV dysfunction

37
Q

what are the 2nd gen dihydropyridines

A

nicardipine

amlopidipine

38
Q

what differs btwn 2nd gen and 1st gen dihydropyridines

A

2nd gen
“vascular selective”
- less inotropic
- less chronotropic

39
Q

effect of amlodipine

A

long duration of action
vasodilation
minimal inotropic effect

40
Q

where do you use amlodipine

A

LV dysfunction

41
Q

Describe verapamil effect

A

1) vasodilators
2) decr HR
3) decr contractility

42
Q

when is verapamil contraindicated

A

LV dysfunction

Nodal disease

43
Q

effects of diltiazem

A

intermediate btwn nifedipine and verapamil

44
Q

what do you use to treat stable angina

A

1) treat lipid, HTN, anti-platelet
2) sublingual nitro
3) aspirin
4) beta blocker or calcium channel blocker
5) long acting nitrate
6) revasc with

45
Q

when do you use beta blockers for stable angina

A

when ischemia due to primary incr O2 demand with fixed supply

46
Q

when do you use calcium channel blockers for stable angina

A

when decr O2 supply caused by alterations to coronary vasomotor tone

47
Q

what do you use to treat variant angina

A

1) Ca2+ channel blockers

2) nitrates

48
Q

what do you avoid in variant angina

A

1) aspirin
2) beta blockers

because exacerbate vasospasm

49
Q

what do you use to treat unstable angina

A

1) hospitalization
2) IV nitro
3) beta blocker
4) antiplatelet (aspirin)
5) anticoag (aspirin, heparin or both)

SPR2015_WEEK4 (14 decks)

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