Quiz 3 Study Guide: Cardiovascular Therapeutics

Question 1

By what 2 mechanisms is angina treated?

Answer 1

1. Vasodilation (Increase flow)
   
   • Nitrates and Nitrites
2. Decrease O2 consumption
   
   • B Blockers; Ca++ channel blockers

Question 2

How do Nitrates/Nitrites work to treat angina?

Answer 2

Metabolize Nitric oxide to increase cGMP therefore relaxing smooth muscle and dilating cardiac vessels

Question 3

What are some examples of Nitrates/Nitrites?

Answer 3

Nitroglycerine

Amyl nitrate

Question 4

Characteristics of Nitroglycerine…

Answer 4

-Sublingual Administration
-Volatile (Sealed Glass bottle)
Long-lasting patches (8hrs)

Question 5

Characteristics of Amyl-Nitrate

Answer 5

• Crushed ampule and fumes inhaled

- Short acting

Question 6

Side effects of Nitrates/Nitrites

Answer 6

Orthostatic hypertension
Tachycardia (reflex to dilation)
Throbbing headache (Vasodilation)

Tolerance develops rapidly

Question 7

How do Ca++ Channel Blockers work to treat angina?

Answer 7

Blocks contraction of smooth and cardiac muscle to reduce O2 demand.

Question 8

What are Ca++ Channel Blockers used for?

Answer 8

Prophylaxis of angina (4-8 hour duration)

“take in the morning to prevent angina during the day”

Question 9

What are examples of Ca++ Channel Blockers?

Answer 9

Verapamil
Nifedipine
Diltiazem

*also used as hypertensives

Question 10

What Toxic side effects can be present with Ca++ Channel Blockers?

Answer 10

• Cardiac depression and bradycardia (Heart Failure)

- Flushing and dizziness.

Question 11

How do B Blockers (B1) work to treat angina?

Answer 11

Decreases Blood output by decreasing the HR, causing BP and contractility to decrease.

• Not a vasodilator
• Prophylactic use

Question 12

What are some examples of B blockers used to treat angina?

Answer 12

Propanolol (Nonselective - Pulmonary problems)

atemolol (B1 selective - less lung problems)

Question 13

What Toxic side effects can be present with B Blockers?

Answer 13

• Asthma

- acute heart failure

Question 14

What are non-drug lipid and cholesterol-lowering treatments?

Answer 14

Dietary

• 15-20% daily intake of fat calories
• avoid red meats

-Exercise

Question 15

What do Statins do?

Answer 15

They are competitive inhibitors of HMG-COA Reductase.

*they reduce the synthesis of cholesterol (LDL) and reduce coronary events.

Question 16

What are some examples of Statins?

Answer 16

Lovastatin (Mevacor)
Atorvastin (Lipitor)
Simvastatin (Zocor)

Question 17

What are side effects of Statin Toxicity?

Answer 17

Liver Damage

Weakness in skeletal muscles.

Question 18

What do Fibrates do?

Answer 18

Increases lipolysis in liver and muscles

*reduces VLDL, modest effect on LDL, and moderate increase in HDL. Reduces Triglycerides.

Question 19

What is an example of a fibrate?

Answer 19

Fenobrate (Tricor)

*side effect is GI symptoms

Question 20

What does Niacin (nicotinic acid) do?

Answer 20

Decreases triglyceride and LDL

*Tolerance develops

Question 21

What is a side effect of Niacin?

Answer 21

Fairly pronounced Mild Flushing.

Question 22

What do Bile acid-binding agents do?

Answer 22

Reduces reabsorption of bile acids and metabolite.

Toxicity: Constipation and Bloating

Question 23

What is and example of a Bile acid-binding agent?

Answer 23

Cholesteramine

Question 24

What do inhibitors of intestinal sterol absorption do?

Answer 24

Inhibits intestinal absorption of cholesterol and reduces LDL.

Question 25

What is an example of and inhibitor of intestinal sterol absorption drugs?

Answer 25

Ezetimibe

Question 26

What is the objective of treatment for patients with heart failure?

Answer 26

Reduce symptoms and slow progression

Question 27

What are the 6 types of drugs that treat heart failure?

Answer 27

``` Positive Ionotropic Drugs B1 adrenoceptor agonists Diuretics ACE Inhibitors Vasodilators B adrenoceptor blockers ``` *Na+ restriction as dietary non-drug treatment

Question 28

What do Positive Ionotropic drugs do?

Answer 28

Increases intracellular Ca++ and Cardiac contractility therefore increasing blood ejection.

Question 29

What are examples of Positive Ionotropic Drugs?

Answer 29

Digitalis (foxglove) | Milrinone -this is really a Bipyridine drug

Question 30

What are side effects of Positive Ionotropic Drugs?

Answer 30

Premature depolarization (arrhythmias) Ectopic beats Affects all excitable tissues

Question 31

What is an example of a B1-adenoceptor agonist?

Answer 31

Dobutamine *can cause arrythmias

Question 32

What do diuretics do?

Answer 32

- Reduce salt and H2O retention and edema | - Reduce venous pressure and ventricular preload

Question 33

What is an example of a diuretic?

Answer 33

Furosemide

Question 34

What do ACE inhibitors do?

Answer 34

Reduce peripheral resistance by reducing salt and water

Question 35

What is an example of an ACE inhibitor?

Answer 35

Captopril

Question 36

What does a Vasodilator do?

Answer 36

Relax smooth muscle

Question 37

What is an example of a Vasodilator?

Answer 37

Hydralazine

Question 38

What does a B adrenoceptor blocker do?

Answer 38

Reduce heart rate and block the Sympathetic Nervous System

Question 39

What is and example of a B adrenoceptor blocker?

Answer 39

metoprolol

Question 40

What are characteristics of Cardiac Arrhythmias?

Answer 40

- 80% with history of Myocardial Infarct - Requires treatment if there is significant reduction in cardiac output - Treatments themselves can cause arrhythmias

Question 41

What types of drugs treat Cardiac Arrhythmias?

Answer 41

Na+ channel blockers B adrenergic blockers Prolong refractory Ca++ channel blockers

Question 42

What do Na+ channel blockers do to treat cardiac arrhythmias?

Answer 42

Slows action potential conduction Effective for most A or V arrhythmias. *can precipitate new arrhythmias.

Question 43

What is an example of a Na+ channel blockers used to treat cardiac arrhythmias?

Answer 43

Procainamide Quinidine Lidocaine (Class 1)

Question 44

Which drug is the 1st choice for ventricular arrhythmias.

Answer 44

Lidocaine *low toxicity

Question 45

What are Prolong refractory drugs used for when treating cardiac arrhythmias?

Answer 45

A fib. or V. arrhythmias

Question 46

What is an example of a Prolong Refractory Drug?

Answer 46

Amiodarone | Class III

Question 47

What is and example of a B blocker used for arrhythmias?

Answer 47

propanolol | Class II

Question 48

What do Ca++ channel blockers do to treat cardiac arrhythmias?

Answer 48

Prolong refractory time | Peripheral Vasodilation

Question 49

What is an example of a Ca++ blocker used to treat arrhythmias?

Answer 49

Verapamil Diltiazem (Class IV)