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27 Cards in this Set
- Front
- Back
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CAD
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narrow/block of coronary arteries = decr blood flow = decr O2 supply to heart
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stages of maifestations of CAD
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Asymptomatic – angina pectoris – MI – sudden death
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angina pectoris
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sudden onset of chest pain due to myocard ischemia, decr blood supply to heart
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angina typical
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chest pain with exertion, due to coronay obstruction/artherosclerosis
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angina typical types
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stable, unstable more dangerous MI risk
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angina variant
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Prinzmetal, chest pain at rest, due to coronary vasospasm
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precipitating factors affecting anginal pain
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exertion, stress, heavy meals (blood to GI), cold weather
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relieving factors affecting anginal pain
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rest, nitrates
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angina treatment
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rest, antianginal drugs, rationale: maintain the balance between O2 supply and demand
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antianginal drugs
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organic nitrates, b blockers, ca channel blockers
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organic nitrates
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esters of NO, short/long acting and combo
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organic nitrates: short acting
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glyceryl trinatrate/nitroglycerin/GTN
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organic nitrates: long acting
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isosorbide dintrate(subling short acting/oral long acting), isosorbid mononitrate
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organic nitrates: mech
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nitrates reduced to NO, incr GC converts GTP to cGMP, incr PKG, decr intracell Ca, relax SM of BV, vasodilation, decr venous BP
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venous dilation
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decr: return/preload, CO, myocardial work, O2 demand
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coronary dilation
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incr blood to heart, incr perfustion, incr O2 supply to ischemic myocard
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arteriolar dilation
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decr periph resistance (afterload), decr blood pressure
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organic nitrates: adverse
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headache (throbbing), flushing, hypotension, tachy, dizzzy, methemoglobenemia (Hb with Fe3+ state), tolerance
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organic nitrates: tolerance
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continuous exposure, prevent with nitrate-free periods (over night), monday disease
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organic nitrates: routes short acting
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rapid onset, subling tabs, oral spray, IV
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organic nitrates: routes long acting
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slow onset, oral tabs, ontment, transdermal patch
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organic nitrates preparations
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GTN: any route except oral tabs, isosorbide dinitrate: subling/tab, isosorbide mononitrate: oral tabs
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CCB: mech
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block L-type voltage-gate Ca channels, prevent Ca flow into vasc SM/vasodilation: arteries not veins, coronaries sensitive, myocard: decr contractility/negative inotropic/decr CO
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CCB: classes
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1 dihydropyridine/nifedipine: vascular selective 2 phenylalkylamine/verapamil: myocard selective, benzothiazepine/dilitiazem: intermediate
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CCB: adverse
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myocard depression (verapamil/diltiazem), change in HR (incr nifedipine/decr bp, decr HR verapamil/diltiazem, hypotension (nifedipine), flushing, ankle swell, headache)
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CCB: indications
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angina (d/v), hypertension (n/d), supraventricular tachy (v)
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antianginals: how to choose
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prevention/termination of attacks (short nitrates/GTN), long term prophylaxis (long nitrates) CCB in variant angina (B blocker non in variant angina), aspirin
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