- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
22 Cards in this Set
- Front
- Back
|
What is angina pectoris?
What are the 2 main mechanisms my which a person experiences angina pectoris? |
Angina pectoris: chest discomfort due to myocardial ischemia
2 mechanisms: atherosclerosis & coronary artery spasm |
|
List the factors that determine myocardial oxygen demand.
List the factor that determines myocardial oxygen supply. (as discussed in class) |
Oxygen demand determinants:
--wall stress --contractility --HR Oxygen supply determinant: --coronary blood flow |
|
While learning about all this cardio stuff, we've come across 3 drugs that produce vessel dilation.
What are they? (hint: 2 are anti-hypertensive, 1 is anti-anginal) |
(1) Arterial dilator (hydralazine)
(2) Arterial & venous dilator (Na nitroprusside) (3) Organic nitrates (nitroglycerin) |
|
List the 3 organic nitrates discussed in class.
What is their mechanism of action? By what 4 ways can they be administered? |
(1) nitroglycerin
(2) isosorbide dinitrate (3) isosorbide-5-mononitrate Mechanism: release NO, which stimulates cGMP production, leading to relaxation Administration: (1) sublingual (2) oral (3) topical (4) IV |
|
Which organic nitrate has almost 100% bioavailability?
|
isosorbide-5-mononitrate
The other 2 -- nitroglycerin & ISDN -- have significant 1st pass metabolism. |
|
How do the organic nitrates affect the following:
-blood vessels -LVEDV -wall tension -BP -HR -contractility |
--cause venous dilation
--dec LVEDV & dec radius --dec wall tension --dec systemic BP --inc HR --inc contractility **the decreased BP causes a SNS reflex to increase the HR & contractility** |
|
How do the organic nitrates affect patients w/ atherosclerotic disease? patients w/ spastic angina?
|
Athersclerosis: organic nitrates cause little inc in overall coronary blood flow; but may cause intracardiac blood flow re-distribution & may cause dec LVEDP
Angina: nitrates relieve coronary spasm Bottom line: nitrates are used to treat both exertional angina & spastic angina |
|
Of the following routes of nitrate administration, which one would be best for relief of an acute angina attack?
a) topical b) oral c) sublingual |
c) sublingual
SL nitroglycerin has a rapid onset of action (2min). Its effect lasts no longer than 30min. |
|
What are some adverse effects of organic nitrates?
|
--headaches
--orthostatic hypotension --rashes --severe hypotensive effect if given to patient taking sildenafil (Viagra) |
|
Nitrate tolerance can develop with continuous exposure. How could you prevent this?
|
interrupt therapy for 8-12hrs per day, which allows the return of efficacy
|
|
Which category of Ca channel blockers has a higher vascular selectivity?
Cause greater vasodilation? Useful in the case of atrial fibrillation? Does not affect AV conduction? Decreases SA node pacemaker rate? |
(1) higher vascular selectivity: nifedipine (dihydropyridines)
(2) Greater vasodilation: nifedipine (3) useful in case of atrial fibrillation: verapamil, diltiazem (non-dihydropyridines) (4) does not affect AV conduction: nifedipine (5) dec SA node rate: verapamil, diltiazem |
|
How do organic nitrates & Na nitroprusside differ in their mechanisms of action?
How do their hemodynamic effects differ? |
ORGANIC NITRATES
Class: anti-anginal drug Mechanism: release NO, leading to cGMP production & relaxtion Effects: vein dilation > arterial dilation; dec LVEDV & dec radius; dec wall tension; dec BP Na NITROPRUSSIDE Class: anti-HTN drug Mechanism: stimulate guanylyl cyclase to inc cGMP Effects: arterial & venous relaxation; rapid onset & offset |
|
How do beta blockers affect the following:
-HR -BP -contractility -LVEDV |
Beta blockers...
-dec HR -dec BP -dec contractility -inc LVEDV |
|
Beta blockers are used to treat
a) exertional angina b) spastic angina c) both |
a) exertional angina
Beta blockers, if used alone, can actually worsen spastic angina. |
|
Ca channel blockers interact with this type of Ca channel...
What happens as a result of this interaction? (what's the mechanism of action) |
Ca channel blockers interact with L-type Ca channels.
These channels are especially concentrated in the SA and AV nodes so Ca channel blockers can be used to decrease impulse conduction through the AV node, thus protecting the ventricles from atrial tachyarrhythmias. Calcium channels are also present in the smooth muscle that lines blood vessels. By relaxing the tone of this smooth muscle, calcium-channel blockers dilate the blood vessels. |
|
TRUE OR FALSE
Nifedipine has a higher cardiac selectivity compared to verapamil. |
FALSE
Nifedipine has a higher VASCULAR selectivity compared to verapamil. |
|
How do the following anti-anginal drugs affect contractility?
-beta blocker -nefidipine -nitroglycerin -verapamil |
(1)beta blockers decrease contractility
(2)nefidipine decrease contractility (but b/c it is more vascular selective, there is more of a SNS reflex to counter) (3) nitroglycerin increases contractility (4) verapamil decreases contractility |
|
This anti-anginal drug has little effect on HR and BP, and may cause an increased Q-T interval.
|
Ranolazine
|
|
Of the following anti-anginal drugs, which 2 treat both spastic and exertional angina?
What do the other 2 treat? (1) Nitrates (2) Beta blockers (3) Ca channel blockers (4) Ranolazine |
Nitrates & Ca channel blockers treat both spastic & exertional angina.
Beta blockers and ranolazine treat exertional angina. |
|
How does nitroglycerin affect the following..
-HR -contractility -LVEDV -BP |
Nitroglycerin causes..
--inc HR --inc contractility --dec LVEDV --dec BP |
|
How do (1) nitroglycerin, (2) beta blockers and (3) Ca channel blockers affect the following...
-HR -contractility -BP |
Beta blockers and Ca channel blockers lead to..
--dec HR --dec contractility --dec BP Nitroglycerin, however, has these effects... --inc HR --inc contractility --dec BP |
|
Sublingual nitroglycerin tablet can relieve an acute attack of this type of angina..
|
SL nitroglycerin can relieve an acute attack of exertional angina.
It can also be used as a prophylaxis. |
