Vasodilators and the Tx of Angina

Question 1

which drugs can be used in the tx of angina

Answer 1

beta blockers and Ca channel blockers

Question 2

what is sudden , severe, pressing chest pain; caused by a decrease in coronary blood flow; leads to ischemia

Answer 2

angina

Question 3

this can result from obstruction of bv ( coronary heart disease), spasm of vascular smooth muscle ( as a response to coronary artery disease)

Answer 3

angina

Question 4

this type of ischemia does not cause cell death

Answer 4

transient ischemia

Question 5

this type of ischemia can lead to deterioration of cardiac function

Answer 5

chronic ischemia

Question 6

how can angina be treated

Answer 6

lifestyle changes, decrease oxygen demand, increase oxygen delivery ( vasodilators)

Question 7

what are the three overlapping patterns of angina

Answer 7

effort-induced, stable, classical ( typical angina); vasospastic or variant ( prinzmental angina), and unstable angina

Question 8

this type of angina is effort induced; most common form ; short lasting, heavy or burning feeling in the chest; caused by reduction of coronary perfusion due to a fixed obstruction of a coronary artery produced by atherosclerosis

Answer 8

classic angina

Question 9

in this type of angina blood supply cannot increase due to obstruction ; heart becomes vulnerable to ischemia; relieved by rest or nitroglycerin

Answer 9

classic angina

Question 10

this type of angina is prinzmetal, variant, vasospastic, or rest angina; uncommon pattern of episodic angina, attacks are unrelated to physical activity, HR, or bp; responds well to coronary vasodilators and Ca channel blockers

Answer 10

vasospastic angina

Question 11

this type of angina is when chest pain occurs with increased frequency, duration , and intensity ; precipitated by progressively less effort ; not relieved by rest or nitroglycerin ; requires hospital admission

Answer 11

unstable angina

Question 12

what are the determinants of cardiac oxygen demand

Answer 12

wall stress ( arterial pressure and ventricular volume), heart rate, contractility-> increase in any of these increases cardiac oxygen demand

Question 13

what are the determinants of coronary blood flow

Answer 13

perfusion pressure ( diastolic), duration of diastole ( refill time ) coronary vascular resistance

Question 14

what are the determinants of vascular tone

Answer 14

arteriolar tone directly controls peripheral vascular resistance ( systolic wall stress), and venous tone determines amount of blood returning to the heart ( diastolic wall stress)

Question 15

how can we relax smooth muscle

Answer 15

1) increase cGMP 2) decrease ic Ca 3) increase cAMP 4) increase K permeability

Question 16

this prevents interaction of myosin with actin

Answer 16

increase cGMP

Question 17

this prevents activation of myosin light chain kinase

Answer 17

decrease ic Ca

Question 18

this increases rate of inactivation of myosin light chain kinase

Answer 18

increase cAMP

Question 19

this prevents depolarization of cell membrane

Answer 19

increase K permeability

Question 20

what can you use to treat angina

Answer 20

organic nitrates, Ca channel blockers, and beta blockers, can also decrease myocardial oxygen requirement by decreasing the determinants of oxygen demand ( HR, ventricular volume, BP, and contractility)

Question 21

this tx for angina causes a rapid reduction in myocardial oxygen demand ( rapid relief of symptoms); first pass metabolism

Answer 21

organic nitrates

Question 22

MoA of this drug is enzyme activation of drug causes release of NO; NO combines with guanylyl cyclase causing an increase in cGMP

Answer 22

organic nitrates ie. sublingual nitroglycerin

Question 23

effects of this drugs include relaxation of smooth muscle in arteries and veins -> decreases venous return to the heart, reduces arterial pressure, and relieves coronary artery spasm

Answer 23

organic nitrates

Question 24

what are some adverse effects of organic nitrates

Answer 24

tachycardia ( reflex response to decreased arterial pressure), orthostatic hypotension ( due to increased venous capacitance ), and HA; tolerance develops rapidly ; need nitrate free intervals to restore sensitivity

Question 25

Muscle contraction requires

Answer 25

Ca

Question 26

what produces depolarization

Answer 26

hypoxia ( ischemia causes increased Ca influx)

Question 27

this Moa involves binding of drug to Ca channel which reduces the frequency of opening in response to depolarization -> relaxation of smooth muscle and reduction of cardiac contractility

Answer 27

Ca channel blockers

Question 28

what are some adverse effects of Ca channel blockers

Answer 28

cardiac depression ie. Nifedipin, verapamil, and diltiazem

Question 29

this MoA inhibits the late phase of the Na current ( reduces ic Na and Ca overload); used mainly to treat chronic angina ; NOT used to treat acute attacks

Answer 29

Na channel blockers

Question 30

these drugs lower the rate and force of heart cxn; not a vasodilator; suppress activation of the heart by blocking beta 1 receptors; decrease HR, contractility, cardiac output, and bp

Answer 30

beta blockers ie. metoprolol and atenolol preferred

Question 31

what is the drug of choice for effort induced angina ; ineffective against vasospastic angina

Answer 31

beta blockers

Question 32

all beta blockers are _______ at high doses

Answer 32

non selective