SIHD nitrates/BB

Question 1

what are the two treatment attacks to preventing and/or reducing ischemia and angina symptoms?

Answer 1

increase myocardial oxygen supply
decrease myocardial oxygen demand

Question 2

what are the targets of increasing myocardial oxygen supply?

Answer 2

dilation of coronary arteries (reduce vasospasm)
collateral blood flow
prolong diastole

Question 3

what are the targets of decrease myocardial oxygen demand?

Answer 3

heart rate
myocardial contractility
intramyocardial wall tension (preload and afterload)

Question 4

how do nitrates affect myocardial oxygen demand?

Answer 4

increase HR
no response myocardial contractility
decrease systolic pressure
double decrease LV volume

Question 5

how do B-blockers affect myocardial oxygen demand?

Answer 5

double decrease HR
decrease myocardial contractility
decrease systolic presure
increase LV volume

Question 6

how does DHP, specifically nifedipine, affect myocardial oxygen demand?

Answer 6

increase HR
no or decrease in myocardial contractility
double decrease in systolic pressure
no or decrease in LV volume

Question 7

how does verapamil affect myocardial oxygen demand?

Answer 7

double decrease HR
decrease myocardial contractility
decreases systolic pressure
no or decrease LV volume

Question 8

how does diltiazem affect myocardial oxygen demand?

Answer 8

decrease HR
no or decrease myocardial contractility
decrease systolic pressure
no or decrease LV volume

Question 9

how does ranolazine affect myocardial oxygen demand?

Answer 9

it doesnt

Question 10

what is the moa of organic nitrates?

Answer 10

nitric oxide donors/releasers lead to activation of guanylate cyclase

Question 11

what is the activity that occurs with organic nitrates?

Answer 11

marked venodilation (decreased preload)
less arteriole dilation (coronary and peripheral)
inhibition of platelet aggregation (minor)

Question 12

are nitrates used to treat acute or chronic angina?

Answer 12

acute only

Question 13

what is the dosing of ISDN?

Answer 13

chewable tabs –> 5 to 10mg once
SL tabs –> 2.5 to 10mg once

Question 14

what are educational points unique to NTG tabs?

Answer 14

keep in original dark container
no safety cap
place under tongue, do not swallow
cotton plug removal
do not store in bathroom/humid place

Question 15

what are the counseling points unique to NTG mist?

Answer 15

spray under tongue, do not inhale
do not shake

Question 16

what are the counseling points for all NTG?

Answer 16

keep on person at all times
need for Rx refills (6 months tabs, 3 year spray)
reinforce technique for administration: sit, time frame, etc
preventative use instructions
911 procedure

Question 17

what are the AE of NTG

Answer 17

HA (throbbing or pulsating sensation)
hypotension – dizziness, lightheadedness, and facial flushing
reflex tachycardia

Question 18

what drug class should be used in caution with NTG?

Answer 18

PDEi
may lower BP too low
avoid NTG if having event after sexual activity requiring PDEi (rest and call 911 if persist)

Question 19

for each PDEi, how long should you wait to use nitrate?

Answer 19

avanafil - 12 hours
sildenafil/vardenafil - 24 hours
tadalafil - 48 hours

Question 20

what drug class should be used to prevent recurrent ischemia and angina symptoms for most patients?

Answer 20

beta blockers

Question 21

what does chronotropy deal with?

Answer 21

HR

Question 22

what does dromotrophy deal with?

Answer 22

conduction velocity

Question 23

what does inotrophy deal with?

Answer 23

contractility

Question 24

what non-CAD drugs act on B2 adrenergic receptors?

Answer 24

epinephrine
isoproterenol
albuterol

Question 25

what is the moa of b-blockers?

Answer 25

competitive, reversible inhibitors of beta adrenergic stimulation by catecholamines

Question 26

what are the desired effects of beta-blockers?

Answer 26

reduce HR reduce myocardial contractility reduce arterial BP (afterload)

Question 27

how do b-blockers affect preload?

Answer 27

slightly increases it which is undesired effect

Question 28

how do b-blockers increase preload slightly?

Answer 28

reduce HR --> increases diastolic filling time --> increases LVEDV --> increases preload

Question 29

what b-blockers have B1 selectivity?

Answer 29

acebutolol atenolol (tenormin) bisoprolol (zebeta) metoprolol (lopressor, toprol xl)

Question 30

what b-blockers have mixed a/b selectivity?

Answer 30

carvedilol (coreg) labetalol (normodyne, trandate)

Question 31

what beta-blocker has mixed B1/B2 receptor selectivity?

Answer 31

propranolol (inderal)

Question 32

what beta blockers have QD dosing?

Answer 32

atenolol bisoprolol metoprolol succinate propranolol LA

Question 33

what beta blockers have other dosing besides QD?

Answer 33

carvedilol - BID metoprolol tartrate - BID propranolol - TID

Question 34

what beta-blocker has the largest effect on blood pressure?

Answer 34

carvedilol (coreg)

Question 35

what beta-blockers are eliminated renally?

Answer 35

atenolol bisoprolol

Question 36

what beta blockers are eliminated hepatically?

Answer 36

carvedilol metoprolol propranolol (mixed)

Question 37

what beta-blockers are influenced by CYP2D6?

Answer 37

carvedilol metoprolol

Question 38

what beta blockers are lipid soluble?

Answer 38

propranolol carvedilol

Question 39

what beta blockers are water soluble?

Answer 39

atenolol bisoprolol

Question 40

what beta blockers have ISA?

Answer 40

pindolol acebutolol AVOID

Question 41

what beta-blockers are cardioselective/B1 selective?

Answer 41

atenolol metoprolol

Question 42

what beta blockers are cardio/non-selective?

Answer 42

propranolol carvedilol

Question 43

what are the cardiac AE of beta blockers?

Answer 43

sinus bradycardia sinus arrest AV block reduced LVEF

Question 44

how should the doses of beta blockers be determined?

Answer 44

initiate at lowest dose titrate to symptom reduction

Question 45

what is the goal REST HR while on BB?

Answer 45

50-60 BPM

Question 46

what is the goal EXERCISE HR while on BB?

Answer 46

under 100 BPM (75% of HR that typically causes angina is over)

Question 47

what should a patient use to treat painful episodes while taking BB?

Answer 47

NTG use