Vasodilators and Anti-anginal medications

Question 1

Factors that affect myocardial oxygen demand

Answer 1

contractility, heart rate, ventricular wall tension (preload)

Question 2

Factors that affect myocardial oxygen supply

Answer 2

coronary blood flow, diastolic BP, coronary artery resistance, regional blood flow distribution, faster heart rate

Question 3

Dilating veins causes

Answer 3

decreased venous return, decreased ventricular end-diastolic pressure, reduced cardiac workload

Question 4

Decreasing peripheral arteriolar resistance causes

Answer 4

decreased vasodilation, reduced oxygen demand, reduced myocardial work

Question 5

muscle contraction occurs when

Answer 5

voltage dependent Ca channels open and Ca comes into the cell

Question 6

decreased intracellular Ca leads to

Answer 6

vasodilation

Question 7

what causes inhibition of Ca release

Answer 7

alpha blockers, organic nitrates, nitrites, angiotensin receptor blockers

Question 8

what inhibits breakdown of cyclic GMP

Answer 8

phosphodiesterase inhibitors

Question 9

NO binds and activates what and has what effect

Answer 9

cytosolic guanylate cyclase which converts GTP to cGMP

Question 10

the overall effect of cGMP is to cause what

Answer 10

smooth muscle relaxation by decreasing intracellular calcium levels

Question 11

Nitroglycerine MOA

Answer 11

forms nitric oxide which activates guanylate cyclase, which increase cGMP and causes vascular smooth muscle relaxation

Question 12

nitroglycerine affect on demand

Answer 12

reduces myocardial demand by decreasing preload because cause venous vasodilation

Question 13

Nitroglycerine ADR

Answer 13

Headache, also hypotension, bradycardia, dizziness, syncope, reflex tachycardia

Question 14

Nitroglycerine and tolerance

Answer 14

tolerance can develop withing 24-48 hours of continuous administration, need a nitrate free period for 10-12 hours

Question 15

Some effects of nitrates

Answer 15

decrease ventricular volume, decrease arterial pressure, decrease ejection time, vasodilation of coronary arteries, increase blood flow to collateral arteries

Question 16

Ways to administer nitroglcerine

Answer 16

oral, intravenous, ointment, transdermal, sublingual, spray

Question 17

Proper use of nitroglycerine sublingual tablet

Answer 17

Sit down, take 1 tablet, wait five minutes, if no relief call 911, take second dose, if no relief take third dose; pt should not drive self to hospital

Question 18

Isosorbide dinitrate (Isordil)

Answer 18

a long acting nitrate with same results as giving nitroglycerine itself, increases availability of NO

Question 19

Isosorbide dinitrate (Isordil) use

Answer 19

acute andina only if pt did not respond to SL nitro, used less common but inexpensive

Question 20

Isosorbide mononitrate (Imdur)

Answer 20

a long acting nitrate that ultimately results in release of nitric oxide

Question 21

isosorbide mononitrate (Imdur) use

Answer 21

not used for acute angina, but chronically for pain prevention, USED REGULARLY

Question 22

Isosorbide mononitrate (imdur) should not be used in patients currently taking

Answer 22

phosphodiesterase inhibitors (viagra, Levitra, cialis)

Question 23

Nitroprusside (Nipride) MOA

Answer 23

peripheral vasodilation of arteries and veins*, very quick acting

Question 24

Most common use for nitroprusside

Answer 24

hypertensive crisis

Question 25

Milrinone (primacor) MOA

Answer 25

a selective phosphodiesterase inhibito in cardiac and vascular tissue, prevent cGMP breakdown, results in vasodilation and has inotropic effect

Question 26

2 forms of milinone

Answer 26

short acting (2 hours) and quick acting (5-15 mins)

Question 27

Main use of milrinone (primacor)

Answer 27

heart failure

Question 28

Nesiritide (Natrecor) MOA and use

Answer 28

binds guanylate cyclase and increases cGMP, used for acute decompensated heart failure

Question 29

3 important facts of nesiritide (Natrecor)

Answer 29

only available IV for short term continuous infusion, and can cause renal failure, very inexpensive

Question 30

Sildenafil (viagra)

Answer 30

Phosphodiesterase inhibitor, 60 min onset last 2-4 hours, take with high fat meal

Question 31

Sildenafil (Revatio)

Answer 31

phosphodiesterase inhibitor, used for pulmonary arterial hypertension

Question 32

ADR of sildenafil

Answer 32

HA, hypotension, priapism, flushing, visual disturbances

Question 33

Tadalafil (Cialis)

Answer 33

PDE inhibitor, erectile dysfunction, niche lasts 36 hours, expensive

Question 34

Tadalafil (adcirca)

Answer 34

PDE inhibitor, BPH, expensive

Question 35

Vardenafil (Levitra)

Answer 35

PDE inhibitor, erectile dysfunction, niche faster onset?

Question 36

Avanafil (Stendra)

Answer 36

PDE inhibitor, me too, 30 min onset?

Question 37

Minoxidil (Loniten, Rogaine) MOA

Answer 37

K channel agonist inhibits voltage gate Ca channel

Question 38

Minoxidil (loniten, rogaine) use

Answer 38

antihypertensive but stimulates hair growth

Question 39

Hydralazine (Apresoline) MOA

Answer 39

potent dilator of arteries, short acting, give 3-4 times a day

Question 40

Hydralazine (Apresoline) uses

Answer 40

Hypertension, not fist line, acute hypertension, IV rapid response (5-10 min), pre-eclamsia, inexpensive

Question 41

Ranolazine (Ranexa) MOA

Answer 41

Inhibits Na channel during cardiac repolarization, reduces Ca concentration

Question 42

Ranolazine (Ranexa) use and benefit

Answer 42

prevent angina, doe not cause tachycardia, or hypotension, minimal ADR and well tolerated drug

Question 43

contraindications of Ranolazinf(Ranexa)

Answer 43

hepatic impairment and CYP3A4 inhibitors, expensive