Week 4: Cardiovascular-Renal Drugs: Vasodilators and the Treatment of Angina Pectoris

Question 1

the most common cause of angina is what?

Answer 1

atheromatous obstruction of the large coronary vessels (CAD)

Question 2

inadequate blood flow in the presence of CAD results in ________ angina, also known as classic angina

Answer 2

effort angina

Question 3

the diagnosis of angina is usually made on the basis of what two things?

Answer 3

history and stress testing

Question 4

transient spasms of localized portions of these vessels, usually associated with underlying atheromas, can also cause significant myocardial ischemia and pain.

Answer 4

vasospastic or variant angia

Question 5

vasospastic angina is also called what?

Answer 5

prinzmetal angina

Question 6

the primary cause of angina pectoris is what?

Answer 6

an imbalance between the oxygen requirement of the heart and the oxygen supplied to it via the coronary vessels.

Question 7

in ______ angina, the oxygen imbalance occurs when the myocardial oxygen requirement increases, especially during exercise

Answer 7

effort angina

Question 8

with angina, the resulting ischemia with an accumulation of _____ ____ usually leads to pain

Answer 8

acidic metabolites

Question 9

an acute coronary syndrome, is said to be present when episodes of angina occur at rest AND there is an increase in the severity, frequency and duration of chest pain in patients with previously stable angina

Answer 9

unstable angina

Question 10

unstable angina is caused by episodes of increased epicardial coronary artery resistance or _______ occurring in the vicinity of an atherosclerotic plaque

Answer 10

small platelet clots

Question 11

unstable angina is considered a medical emergency due to the high risk of what?

Answer 11

myocardial infarction and death

Question 12

in effort angina, o2 demand can be reduced by decreasing cardiac work or by shifting myocardial metabolism to substrates that require less oxygen per unit of what?

Answer 12

adenosine triphosphate (ATP) produced

Question 13

in variant angina, spasms of coronary vessels can be reversed by ____ or _______.

Answer 13

nitrates or CCB vasodilators

Question 14

in unstable angina, vigorous measures are taken to achieve BOTH an increase in o2 delivery by medical or physical interventions and a decrease in _______ demand

Answer 14

oxygen

Question 15

the three-drug groups traditionally used in angina

Answer 15

organic nitrates
CCBs
B-Blockers

Question 16

because of their slow onset of action, CCBs and B-blockers are used for angina ________.

Answer 16

prophylaxis

Question 17

Nitroglycerin is denitrated by mALDH in smooth muscle and other cells. This results in the release of nitrite ion, which is then converted to nitric oxide. Nitric oxide that is released stimulates guanylyl cyclase in smooth muscle, producing an increase in ______ which causes vasodilation.

Answer 17

cGMP

Question 18

The major acute toxicities of organic nitrates are direct extensions of therapeutic vasodilation:

Answer 18

orthostatic hypotension, tachycardia, and a throbbing headache.

Question 19

Nitrates are contraindicated if the _______ is elevated.

Answer 19

intracranial pressure

Question 20

With continuous exposure to nitrates, the isolated smooth muscle may develop complete tolerance (__________), and the intact human becomes progressively more tolerant when long-acting preparations (oral, transdermal) or continuous intravenous infusions are used for more than a few hours without interruption.

Answer 20

tachyphylaxis

Question 21

with nitrates, supplementation of______ may partially reverse tolerance, suggesting that reduced availability of sulfhydryl donors may play a role.

Answer 21

cysteine

Question 22

potential deleterious effects of nitrate-induced vasodilation

Answer 22

reflex tachycardia
reflex increase in contractility

Question 23

Calcium channel-blocking agents also relieve and prevent focal coronary artery spasms in ______ angina

Answer 23

variant angina

Question 24

CCB can be used as prophylactic treatment for what kind of angina

Answer 24

variant angina

Question 25

verapamil and diltiazem decrease _______ ________ conduction and are often effective in the management of supraventricular reentry tachycardia and in decreasing ventricular rate in atrial fibrillation or flutter.

Answer 25

atrioventricular nodal

Question 26

Although they are not vasodilators (with the exception of carvedilol and nebivolol), β-blocking drugs are extremely useful in the management of ______ angina and are considered the prophylactic treatment of choice.

Answer 26

effort angina

Question 27

Reduction of ______ and ______, and consequently decreased myocardial oxygen consumption, appear to be the most important mechanisms for the relief of angina and improved exercise tolerance.

Answer 27

heart rate and blood pressure

Question 28

Beta-blockers may also be valuable in treating _____or ambulatory ischemia.
- Because this condition causes no pain, it is usually detected by the appearance of typical electrocardiographic signs of ischemia.
- The total amount of “ischemic time” per day is reduced by long-term therapy with a β blocker.

Answer 28

silent

Question 29

Contraindications to the use of β blockers are:

Answer 29

asthma and other bronchospastic conditions,
severe bradycardia,
atrioventricular blockade,
bradycardia-tachycardia syndrome,
severe unstable left ventricular failure