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cardiology #2 > PHARM-- antianginals > Flashcards

PHARM-- antianginals Flashcards

1
Q

patients with NSTEMI are not candidates for __

A

fibrinolytics

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2
Q

4 general effects of fibrinolytic therapy

A
  • sx resolution
  • get hemodynamic stability
  • reduce biomarker
  • resolve ST elevation
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3
Q

block NE release to decrease cardiac work and myocardial oxygen consumption

A

BB

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4
Q

decreases HR, contractility, SBP; cardioprotective; antiarrhythmic properties

A

beta blocker

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5
Q

which beta blocker targets Alpha, B1, B2

A

carvedilol

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6
Q

which BB Targets B1 but at higher dose can target B2

A

metroprolol

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7
Q

these are indications for what class?

  • For 3 yrs in all w/ normal LV function after ACS
  • all who have LV dysfunction (EF < 40%) w/ HF or prior MI
  • Chronic therapy in all other ppl w/ SIHD or other vasc. dz
A

beta blocker

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8
Q

which class has C/I of

  • High degree heart block
  • Sick sinus syndrome
  • Severe asthma/COPD (caution)
  • Vasospastic angina
A

BB

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9
Q

which class has the ADR of

  • Hypotension, brady
  • 1st deg. Heart block
  • Bronchospasms
  • Glucose intolerance (non-vasodilating BB)
  • Impotence
  • Feeling cold
A

Beta blocker

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10
Q

you should titrate your BB to HR of ____ at rest, ____ during exercise

A
  • at rest: 55-60 bpm
  • w/ exercise: < 100 bpm
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11
Q

which BB is preferred in pts w/ DM

A

Carvedilol

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12
Q

which type of CCB is preferred in Afib, a flutter

A

non DHP

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13
Q

which type of CCB is preferred if on BB already

A

DHP

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14
Q

which type of CCB is preferred in HFrEF

A

DHP

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15
Q

which type of CCB is a potent arterial vasodilator w/ variable to no inotropic effects

A

DHP- CCB

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16
Q

which type of CCB is a moderate vasodilator w/ significant SA and AV conduction inhibition, negative chronotropic and ** inotropic** effects

A

non-DHP

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17
Q

block transmembrane Ca currents in vascular smooth muscle to cause arterial vasodilation

A

CCB

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18
Q

effect of ____

* Direct vasodilation of epicardial arterials to ↑ O2 supply
* ↓ myocardial O2 demand by reducing systemic vascular resistance & systolic pressure
* No effect on exercise; no tolerance issues

A

CCB

19
Q

which type of CCB does this extra thing:

↓ myocardial O2 demand *by decreasing HR and contractility *

A

non-DHP

20
Q

Drug of choice for reducing sx w/ vasospastic angina

A

CCB

21
Q

these are ADR seen in which type of CCBs

increased angina, gingival hyperplasia

A

DHP

22
Q

these are ADR seen in which type of CCBs

bradycardia, AV block, sinus node dysfunction

A

Non-DHP

23
Q

these are common ADR of what class

Hypotension, worsening HF, peripheral edema, constipation, HA, flushing, dizzy

A

CCBs

24
Q

increased cGMP levels cause less intracellular Ca release to produce vascular smooth muscle relaxation

A

nitrates

25
Q

increased cGMP levels cause less intracellular Ca release to produce vascular smooth muscle relaxation

A

nitrates

26
Q

First line for Immediate relief of angina

A

short acting nitrates

27
Q
  • ↑ myocardial supply by direct vasodilation of large epicardial arterials & reduces vasospasms
  • ↓ myocardial demand by venous dilation (decrease preload) and arterial dilation (decreases afterload & BP)
  • Improve exercise tolerance and time to onset of angina
A

nitrates

28
Q

C/I inclues using erectile dysfunction meds (sildenafil, vardenafil, tadalafil)

A

nitrates

29
Q

ADR of

  • Hypotension, HA
  • Flushing
  • Reflex tachy.
    * tolerance
  • Methemoglobinemia
  • Syncope, Dizziness, palpitations
A

nitrates

30
Q

how do you manage nitrate tolerance

A

nitrate free interval each day (12 for patch, 8-12 for tabs)

31
Q

which med should not be stopped abruptly, d/t rebound tachy

A

nitrates

32
Q

blocks late Na+ channel to stop late sodium entry into myocardial cell which decreases Ca entry (Na-Ca exchanger) to decrease wall tension (myocardial oxygen demand)

A

ranolazine

33
Q

has no effect on HR and BP; prolongs exercise duration and time to angina

A

ranolazine

34
Q

used in combo w/ BB, CCB, LA nitrates for refractory angina & NOT to be used in acute anginal episodes

NOT a sole indicator

A

ranolazine

35
Q

has these C/I

  • Severe renal impairment (CrCl < 30ml/min)
  • Liver cirrhosis
  • Use of clarithromycin, antiretroviral meds, azole antifungals
A

ranolazine

36
Q

use caution when giving this medication in Existing QT prolongation or with meds that also do it (Class Ia or III antiarrhythmics except amiodarone)

A

ranolazine

37
Q

has these ADR

  • Dose dependent QT prolongation
  • Dizziness
  • HA
  • Nausea
  • Constipation
  • asthenia
A

ranolazine

38
Q

thrombolytic made from recombinant DNA

A

altepase (rTPA)

39
Q

dissolves stable fibrin rich clots by activating plasminogen to plasmin

A

rTPA, RPA, TNK

40
Q

The most fibrin specific of the three; used in STEMI but not pulmonary embolisms

A

tenecteplase (TNK)

41
Q

which two fibrinolytics is from the mutant of human wild-type

A

RPA & TNK

42
Q

3 scenerios of using fibrinolytics in STEMI

A
  • STEMI w/in 12hrs of ischemia/sx onset
  • w/in 12-24 hrs + sx of ongoing ischemia
  • Time to hospital for PCI >120 mins
43
Q

rank the antianginals in order of 1st line through 4th line

A
  1. Beta blockers
  2. CCB
  3. Nitrates
  4. ranolazine
44
Q

Avoid IV NTG in patients w/ ____

A

right ventricular infarcts

cardiology #2 (12 decks)

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