Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
29 Cards in this Set
- Front
- Back
angina pectoris
|
-primary symptom of ischemic heart disease
-dt an imbalance btw myocardial O2 supply and demand -chest pain occurs dt accum of metabolites resulting from ischemia |
|
typical stable angina
|
-continuous obstruction of large vessels due to atheroma
-pain on exertion |
|
variant angina
|
-spastic, Prinzmetal's
-transient spasm of localized portions of large coronary vessels -usually assoc with underlying atheromas -15% of cases |
|
unstable angina
|
-crescendo
-changes or worsens rapidly -assoc with high risk for MI and death |
|
determinants of O2 demand
|
-contractile state
-HR -wall tension (systolic from afterload, diastolic from preload) |
|
law of LaPlace
|
tension= pressure*radius/ thickness
|
|
coronary blood flow in stable angina
|
-reduced blood flow dt reduced pressure gradient
-can be diminished furher with inc intraventricular pressure -inc HR also dec subendocardial blood flow |
|
coronary blood flow in variant angina
|
-vasospasm results in transmural ischemia
|
|
pharmacotherapy for acute vs chronic stable angina
|
-acute: fast-acting nitrates
-chronic: B-blockers, nitrates, CCBs |
|
pharmacoptherapy for acute vs chronic variant angina
|
-acute: fast-acting nitrates
-chronic: CCBs |
|
nitrate uses
|
-acute episodes of angina
-chronic treatment of typical stable angina |
|
nitrate mech's
|
-denitrated by glutathione s-transferase --> free nitrate released and converted to NO
-NO activates guanylyl cyclase, inc cGMP -general vasodilator, larger effect on veins |
|
nitrate effects
|
-inc venous capacitance and dec preload
-results in reduced wall tension and therefore O2 demand -dec preload= minor effect to inc subendocardial blood flow -small dec in afterload from arterial dilation -coronary vasodilator |
|
nitrate pharmacokinetics
|
-nitroglycerin and isosorbide dinitrate inactivated in liver
-low oral bioavailability |
|
nitrates used for acute episodes
|
-nitroglycerin (sublingual)
-isosorbide dinitrate (sublingual) |
|
chronic therapy
|
-isosorbide dinitrate (extensive first pass)
-isosorbide mononitrate (NO first pass) -nitroglycerin (tablet, patch, ointment) |
|
nitrate s/e
|
-CV actions
-hypotension, otrho hypoTN, tachy, throbbing headache (menigeal vasodilation) |
|
tolerance to nitrates
|
-complete tolerance can develop if used for more than a few hours
-also reverse rapidly (24h after stop taking drug) -develops with ALL nitrates |
|
B blockers to treat angina
|
-mainly used for chronic treatment of typical stable angina
-blocks postive iono and chronotropic actions of catecholamines on heart mediated by B1 -dec HR, contractility, bp -small inc in O2 supply to ischemia areas (dt dec HR) |
|
b blocker c/i
|
-asthma and bronchspasm
-bradycardia -AV block -caution in pts with coronary spasm |
|
CCBs and angina
|
-dec HR, contractility, wall stress (secondary to dec bp)
-inc endocardial blood flow (dec HR and dilate vessels) -relieve and help prevent spasms |
|
CCBs and stable angina
|
-verapamil and diltiazem
-greater effects on cardiac muscle |
|
CCBs and vasospastic angina
|
-nifedipine
-more pronounced vascular actions -should be used with a B blocker to prevent hypotension and reflex tachycardia |
|
ranolazine
|
-blocks Na+ current in cardiac muscle during ischemia
-results in dec Ca overload during ischemia -only used in typical stable angina unresponsive to other therapies |
|
combo therapy and wall tension
|
-nitrates prevent it
-B blockers produce it |
|
combo therapy and HR
|
-nitrates inc HR and contractility
-B blockers prevent it |
|
combo therapy and vasospasm
|
-nitrates prevent it
-b blockers cause it |
|
combo therapy and oxygen consumption
|
-both reduce it
-nitrates dec preload -b blockers dec work of the heart |
|
combo therapy and subendocardial blood flow
|
-both increase it
-nitrates dec preload, improve gradient -b blockers dec HR |