SM 132 CAD Pharmacology

Question 1

What factors influence Oxygen demand?

Answer 1

Heart Rate, Contractility, Wall Tension

Question 2

What pathway are Nitrates associated with?

Answer 2

Nitrates activate the cGMP pathway to cause vasorelaxation

Question 3

What are Nitrates primarily used for?

Answer 3

Short term relief of acute chest pain

Question 4

How do Nitrates work?

Answer 4

Nitrates cause VENOdilation, reducing myocardial wall tension and therefore reducing oxygen requirements

Question 5

What are Direct Renin Inhibitors?

Answer 5

Block the first step in the activation of the renin-angiotensin pathway to treat congestive heart failure

Question 6

What does platelet activation result in?

Answer 6

Expression of GP IIbIIIa receptor and a change in shapde

Question 7

What are the low molecular weight heparins?

Answer 7

Enoxaparin and Dalteparin

Inhibit Factor Xa > Factor II

Question 8

What factors can activate platelets?

Answer 8

Shear stress, ADP, Epinepthrine, Collagen, Thrombin

Question 9

Which Beta Blocker has a long half life?

Answer 9

Nadolol

Question 10

What is required for GP IIbIIIa expression, and what role does it mediate?

Answer 10

Platelet activation is required for GP IIbIIIa expression

GP IIbIIIa mediates binding to Fibrinogen

Question 11

How do Aldosterone receptor antagonists work?

Answer 11

Block the interaction of Aldosterone with its receptor, leading to lower blood pressure and lower sodium retention

Question 12

What class of drugs does Ticagrelor belong to?

Answer 12

Ticagrelor is a Triazolopyrimidine

NOT a Thienopyridine like Clopidogrel and Prasugrel

Question 13

How do Thienopyridines work?

Answer 13

Inhibit P2Y12 ADP receptor mediated activation of platelets to reduce clot formation

Question 14

Name an example of an Aldosterone receptor antagonist?

Answer 14

Spironolactone

Question 15

What effect does increasing dose have on a Beta Blocker?

Answer 15

Higher doses of a Beta Blocker are less specific to Beta1 or Beta2 receptors

Question 16

Why is Reocclusion a risk with fibrinolytic reperfusion?

Answer 16

Fibrinolytic reperfusion does nothing to address the causes of clot formation, and only breaks an existing clot, so another could reform later

Question 17

What are the side effects of Beta Blockers?

Answer 17

Sedation and Asthma

Question 18

What are Beta Blockers primarily used for?

Answer 18

Reduce mortality and reinfarction after MI

Question 19

What are the advantages of Fibrinolytic reperfusion over surgical approaches?

Answer 19

Universally available
Ease of use
Rapid administration

Question 20

What are the GP IIbIIIa inhibitors?

Answer 20

Abciximab, Tirofibin, Eptifibatide

Prevent platelet aggregation

Question 21

How do Calcium Channel Blockers work?

Answer 21

Block Calcium channels in the vascular smooth muscle and myocardium resulting in improved myocardial blood flow and lower blood pressure

Question 22

Which Beta Blocker is nonspecific?

Answer 22

Propranolol; blocks both Beta1 and Beta2 receptors

Question 23

When are plasminogen activators used?

Answer 23

Rapid dissolution of a clot during STEMI

Question 24

What factors influence Oxygen supply?

Answer 24

Coronary Blood Flow is set by Diastolic Time, Collateral supply, and the Aortic Diastole - LVEDP gradient

Question 25

How do ARB works?

Answer 25

Angiotensin Receptor Blockers prevent binding of Angiotensin II to the AT1 receptor, effecting the vasculature, heart, kidney, and muscle Useful for Heart Failure, Left Ventricular Systolic Dysfunction, Hypertension

Question 26

How does Ticagrelor work?

Answer 26

Inhibits platelet activation via ADP receptor pathway

Question 27

How do plasminogen activators work?

Answer 27

They cleave Plasminogen into Plasmin and degrade the fibrin strands holding a thrombus together

Question 28

What are the plasminogen activators?

Answer 28

Streptokinase, Alteplase, and Tenecteplase

Question 29

What functions does ACE have other than the conversion of Angiotensin?

Answer 29

ACE inactivates Bradykinin and Enkephalins ACE inhibitors potentiate Bradykinin and cause cough

Question 30

How do Beta Blockers work?

Answer 30

Beta Blockers lower HR and improve Diastolic Filling Time, lowering BP and preventing exercise induced increases in myocardial contractility

Question 31

What are the main side effects of Nitrates?

Answer 31

Headache and dizziness; rapid development of tolerance

Question 32

What gradient determines coronary perfusion?

Answer 32

The gradient between Aortic Diastolic Pressure and LVED determines the coronary perfusion

Question 33

How does Ranolazine work?

Answer 33

Ranolazine reduces the late inward Na current in ischemic myocardium, thereby lowering intracellular Na and restricting Na/Ca exchange, ultimately lowering contractility

Question 34

What is the most common side effect of Verapamil and Diltiazem?

Answer 34

Bradycarida and heart failure

Question 35

How do Triazolopyrimidines compare to Trhienopyridines?

Answer 35

Triazolopyrimidines are reversible, active drugs with rapid onset Thienopyridines are irreversible, prodrugs with slow onset Triazolopyrimidines include Ticagrelor Thienopyridines include Clopidogrel and Prasugrel Both Triazolopyrimidines and Thienopyridines effect P2Y12 receptors

Question 36

When is Warfarin the anticoagulative of choice?

Answer 36

OVAHP ``` Outpatient setting Venous Thromboembolitic Disease Heart Valves Atrial Fibrillation Prior Emboli ```

Question 37

What are the side effects of ARB?

Answer 37

Minimal

Question 38

What can Beta Blockers not improve?

Answer 38

Beta Blockers cannot improve Oxygen supply, only decrease Oxygen demand

Question 39

What is the suffix of ACE inhibitors?

Answer 39

-pril

Question 40

How do ACE inhibitors work?

Answer 40

ACE Inhibitors prevent the formation of Angiotensin II from Angiotensin I Used for Hypertension, Heart Failure, MI

Question 41

What drugs fall in the Thienopyridine class?

Answer 41

Clopidogrel and Prasugrel NOT Ticagrelor

Question 42

Name an example of a DIrect Renin Inhibitor?

Answer 42

Aliskiren

Question 43

What are the disadvantages of Fibrinolytic reperfusion over surgical approaches?

Answer 43

Hemorrhage/stroke risk Reocclusion Contraindications ~50-60% optimal flow restoration

Question 44

Why is Tenecteplase the best fibrinolytic agent?

Answer 44

Dosed as a single bolus, high fibrin specificity to a specific clot, directly activates Plasminogen and is not antigenic

Question 45

Why might a fibrinolytic reperfusion agent like Streptokinase cause ICH?

Answer 45

Intracranial hemorrhage can arise after an agent like Streptokinase is administered because healthy clots are broken as well, potentially leading to ICH

Question 46

What is the suffix of ARB drugs?

Answer 46

-artan

Question 47

How do Dihydropyridine and Non-dihydropyridine agents differ in their effects on heart rate?

Answer 47

Both are Calcium channel blockers Dihydropyridines increase HR while Non-dihydropyridines decrease HR

Question 48

What are the side effects of ACE Inhibitors?

Answer 48

Nonproductive cough

Question 49

How does the GP IIbIIIa receptor affect platelet function?

Answer 49

Activation of the receptor allows platelets to tightly bind eachother, with Fibrinogen acting as the connection between two platelets

Question 50

What are the effects and outcomes of Calcium antagonists?

Answer 50

Calcium antagonists inhibit vasoconstriction and enhance ventricular relaxation Decrease Oxygen demand and increase Oxygen supply

Question 51

How do small molecule GP IIbIIIa inhibitors compare to peptide inhibitors?

Answer 51

Small molecule inhibitors have a shorter half life and need continuous IV infusion

Question 52

How does the dose of aspirin determine it's effects?

Answer 52

Low dose aspirin inhibits Thromboxane A2 synthesis, opposing clots High dose aspirin inhibits Prostacyclin synthesis, promoting clots

Question 53

What are the Dihydropyridines?

Answer 53

Calcium Channel Blockers FANN Felodipine Amlodipine Nifedipine Nicardipine All are arterial vasodilators

Question 54

What are GP IIbIIIa inhibitors used for?

Answer 54

Angioplasty and stenting

Question 55

Which Beta Blocker has anti alpha-adrenergic effects?

Answer 55

Carvedilol

Question 56

What are the effects and outcomes of Nitrates?

Answer 56

Nitrates cause vasodilation and decrease preload Decrease Oxygen demand and improve Oxygen supply

Question 57

What are the side effects of Dihidropyridines?

Answer 57

Pedal edema

Question 58

What are the effects and outcomes of Beta Blockers?

Answer 58

Beta Blockers treat chronic angina by decreasing HR, contractility, and BP Decrease Oxygen demand