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Pharm Exam 2 > Topic 9 > Flashcards

Topic 9 Flashcards

1
Q

4 calcium channel blocker categories

A

Organic Nitrates
Sodium Channel Blockers
Calcium Channel Blockers
β-Blockers

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2
Q

5 types of angina

A

1) “Classic”, “Stable”, or “Effort-Induced”
2) “Unstable”
3) “Variant”, “Rest”, “Vasospastic”, or “Prinzmetal”
4) “Acute Coronary Syndrome”
5) “Mixed”

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3
Q

Most common type of angina

A

Classic

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4
Q

Classic angina is caused by

A

a fixed coronary artery obstruction

generally atheromatous

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5
Q

With classic angina, the pattern of pain remains

A

stable

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6
Q

With classic angina, the pain is relieved by

A

rest or nitroglycerin

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7
Q

Unstable angina=

A

Pain at rest or with increasing frequency,
duration, severity, or as the result of less
exertion

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8
Q

With unstable angina, pain is

A

not relieved by NTG or prolonged (>20 minutes) rest

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9
Q

With Prinzmetal angina, pain is

A

episodic and unrelated to exertion

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10
Q

Prinzmetal angina: Although patient might have

atherosclerosis, angina is the result of

A

arteriospasm and unrelated to exertion or rest

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11
Q

Treat Prinzmetal angina with

A

NTG

Calcium Channel Blockers

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12
Q

Acute coronary syndrome=

A
  • Atheromatous plaque ruptures
  • Inflammatory cells and mediators are activated
  • “Lipid Pool” forms
  • Thrombus forms and propagates
  • Vasoconstriction occurs
  • Vascular occlusion occurs
  • Cardiac muscle sickens and dies
  • Characteristic MI “biomarkers” are released
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13
Q

Mixed angina=

A
  • Patients have angina during exertion and at rest.

- Caused by a fixed obstruction combined with vasospasm &/or endothelial disruptions

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14
Q

Angina treatment strategies include

A

Increase O₂ delivery

Decrease O₂ demand

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15
Q

Determinants of myocardial O2 consumption

A
  1. Wall stress (Intraventricular pressure, Ventricular radius/volume, Wall thickness)
  2. Heart rate
  3. Contractility
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16
Q

The heart extracts ___% of oxygen delivered to it

at rest.

A

75%

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17
Q

Arterial blood pressure determines how

much

A

myocardial wall stress is necessary to overcome that resistance and pump blood

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18
Q

arterial (overwhelmingly arteriolar) tone determines

A

SVR ~~ systolic wall stress

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19
Q

Venous (capacitance) tone determines

A

~~diastolic wall stress.

how much blood can be “stored” in the venous blood delivery system before it’s returned to the heart

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20
Q

Organic Nitrates and Nitrites causes

A

rapid decrease in my0₂cardial demand and prompt relief of stable, unstable, and variant angina

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21
Q

Organic Nitrates and Nitrites all work similarly and differ in their

A

onset and duration of action

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22
Q

Organic Nitrates and Nitrites include (4)

A

Nitroglycerin (Nitrobid)
Nitroprusside (Nipride)
Isosorbide mononitrate (Imdur)
Isosorbide dinitrate (Isordil)

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23
Q

Nitroglycerin

A

Nitrobid

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24
Q

Nitroprusside

A

Nipride

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25
Isosorbide mononitrate
Imdur
26
Isosorbide dinitrate
Isordil
27
most commonly used nitrate/nitrite and one you will become most comfy with is...
Nitroglycerin
28
``` Organic Nitrates and Nitrites Side Effects (3) ```
*Cyanide toxicity and Nipride *Reflex tachycardia (myo₂ cardial demand and coronary perfusion via diastolic filling) * Reflex positive inotropy (myo₂cardial demand)
29
Organic Nitrates and Nitrites | High sustained doses can cause
methemoglobinemia | -particularly in peds exposed to Tylenol exposure
30
methemoglobinemia=
blood with an oxidized heme group | Chocolate brown blood
31
methemoglobinemia treatment
1. Prepare to give methylene blue at 1-2 mg/kg (up to 50 mg) IV over 3-5 minutes 2. ascorbic acid 3. lots of pure O2
32
methemoglobinemia patient that is unresponsive treatment
they may be deficient in the enzyme glucose-6-phosphate dehydrogenase (G6PD)
33
G6PD- deficient patients who don’t respond to methylene blue and ascorbic acid require
1) Exchange transfusions | 2) Hyperbaric oxygen
34
Sodium channel blockers=
- Effect the transmembrane sodium/calcium exchange. | - Less calcium enters the cardiomyocyte to relieve the cardiac workload
35
Sodium channel blocker drug name
Ranolazine (Ranexa)
36
Ranolazine
Ranexa
37
Sodium channel blockers act by
shifting cardiac metabolism from fatty acids...to carbs | -Which require less O₂ to metabolize
38
The calcium cardiac transmembrane current is critical in
myocardial contraction
39
Cardiac ischemia decreases the transmembrane | potential..... then...
increases the Ca⁺⁺ flow into cells which activates ATP- consuming systems which causes a positive feedback loop- contributing to even more profound ischemia
40
Calcium channel blockers can worsen
heart failure
41
Smooth muscle is dependent on an inflow of
Ca++ to maintain tone
42
As those Ca⁺⁺ channels are “blocked”...
inner circular and outer longitudinal vascular smooth | muscles relax.
43
Arteries are much more affected by Ca⁺⁺ channel blockade, which causes
arterial dilate, SVR drops, and arterial pressure falls
44
Calcium channel blockers do what to afterload and O2 consumption/delivery
decreases afterload= decreases myO₂ cardial consumption dilate coronary arteries= increases myO₂cardial delivery)
45
Calcium channel blockers have the potential to worsen heart failure because
- does not allow the heart to complete action potential- heart depolarizes but cannot re polarize
46
Calcium Channel Blockers drugs
Verapamil (Calan, Isoptin) Diltiazem (Cardizem) Nifedipine (Procardia)
47
Verapamil
(Calan, Isoptin)
48
Diltiazem
(Cardizem)
49
Nifedipine
(Procardia)
50
Calcium channel blockers are are differentiated by their
ability to affect the myocardium vs. vascular smooth muscle
51
Nifedipine is a derivative of
dihydropyridine
52
Nifedipine is almost exclusively a
vasodilator with little dromotropic or chronotropic effect
53
Nifedipine- D.O.C. for
variant angina
54
Nifedipine Causes reflex
tachycardia
55
Verapamil is a derivative of
diphenalkylamine
56
Verapamil effects
Strong negative dromotropic, chronotropic, and inotropic effects. Weak vasodilatory effects
57
Verapamil Dramatically decreases impulse conduction through the
SA & AV nodes | -which are rich in calcium pumps
58
Verapamil- D.O.C. for
many supraventricular tachyarrhythmias, such as SVT
59
Diltiazem Classified as a
benzothiazepine
60
Diltiazem has a mixture of
vasodilatory and cardiac effects
61
Diltiazem is less____ than verapamil
Less negative chronotropic and dromotropic
62
Diltiazem is less _____ than nifedipine
less decrease in SVR and reflex tachycardia
63
Diltiazem is Utilized extensively to prevent
radial artery spasm during harvest and post-operatively to maintain patency
64
β- Blockers act as
negative chronotropes and inotropes to decrease myO₂cardial consumption
65
β- Blockers DOC
for exercise induced angina
66
β-Blockers and Ca⁺⁺ Channel Blockers are commonly administered with
nitrates
67
Drugs commonly used for treating angina with: | Concomitant disease: None
Long acting nitrate B-Blockers Ca-Blockers
68
Drugs commonly used for treating angina with: | Concomitant disease: Recent MI
Long acting nitrate | B-Blockers
69
Drugs commonly used for treating angina with: | Concomitant disease: Asthma, COPD
Long acting nitrate | Ca-Blockers
70
Drugs commonly used for treating angina with: | Concomitant disease: HTN
Long acting nitrate (less effective) B-Blockers Ca-Blockers
71
Drugs commonly used for treating angina with: | Concomitant disease: Diabetes
Long acting nitrate | Ca-Blockers
72
Drugs commonly used for treating angina with: | Concomitant disease: Chronic renal disease
Long acting nitrate B-Blockers (less effective) Ca-Blockers

Pharm Exam 2 (9 decks)

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