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35 Cards in this Set

  • Front
  • Back
cause of classic angina
coronary atherosclerosis
cause of variant angina
vasculospasm
cause of unstable angina
can be triggered at any time


cause may be coronary thrombosis?
clinical test for classic angina
angiogram or graded stress test
treatment for classic angina
bypass, angioplasty, stent
clinical test for variant angina
ergonovine provacative test
ergonovine
mixed vasculoconstrictor. activates serotonin, alpha-1, the whole bag. vessels susceptible to spasm will constrict

used to induce vasculospasm in ergonovine provocative test. have nitroglycerin on hand
treatment for variant angina
coronary vasodilators
treatment for unstable angina
thrombolytic agents (baby aspirin, streptokinase, rTPA)
cause of mixed angina
combination of classic, variant, and unstable anginas

example: stiff atherosclerotic artery undergoes vasculospasm and cracks, exposing BM and causing a thrombus
3 major determinents of myocardial oxygen demand?
1. systolic wall tension
2. contractility
3. heart rate
la place's law?
T=IVP * r / (2 * t)
why is increasing heart wall thickness to decrease wall tension self limiting (as in CHF)?
The thicker wall is more rigid and less compliant. It is also harder to perfuse with oxygen.
what are the effects of nitroglycerin and propanolol on ventricular wall tension, heart rate, and contractility?
NG is a venodilator and decreases VR and decreases EDV. This decreases radius. It has no effect on thickness. It decreases systolic blood pressure, but this causes reflex tachycardia and reflex increased contractility.

propanolol decreases HR, contractility, and systolic BP. The decreased HR gives the ventricles more time to fill and increases EDV, increases radius.
why are nitroglycerin and propanolol best in combination therapy?
NG keeps EDV from going up, and propanolo keeps reflex cardiac stimulation from occuring.
Nitrates and Nitrites - method of action?
nitroglycerin, nitrates, and nitrites - all eventually cause increase in NO, which activates guanylyl cyclase, which increases cGMP, which causes relaxation
why does cAMP in cardiac muscle cause contraction and cAMP in smooth muscle cause relaxation?
cardiac muscle - cAMP -> PKA -> phosphorylation and activation of Calcium channels.

Smooth muscle: cAMP -> pKA -> phosphorylation and inactivation of MLCK -> decreases contraction
why does cGMP work better than cAMP in relaxing smooth muscle? (this is NO working better than NE)
cGMP -> PKG -> inactivation of MLKC & inactivation of MLC
PKG also decreases intracellular Ca by activating SERCA, inhibitting the IP3 receptor on the SR, and inactivating K channels, hyperpolarizing the cell and decreasing Ca entry.
side effects of nitrates/nitrites
headaches, flushing sensation, postural hypotension (due to venous pooling), METHEGLOBINEMIA
how do calcium channel blockers help angina?
decrease contractility (cardiac muscle) and cause vasodilation (VSM)

I and II vs III?
what are the differences between Class I, II, and III calcium channel blockers?
Class I and II are cardiac channel blockers (like propanolol) + coronary vasodilation

Class III are vascular smooth muscle vasodilators.
(like nitroglycerin) + coronary vasodilation
what is the difference between verapamil and nifedipine's affinities for calcium channel states?
verapamil has a higher affinity for open channels, and nifedipine has a higher affinity for inactivated channels
why is verapamil a better blocker for cardiac channels and nifedipine for vascular smooth muscle calcium channels?
verapamil has a high affinity for open channels, and cardiac channels are constantly cycling.

nifedipine has a higher affinity for inactivated channels, and vascular smooth muscle channels do not cycle as much.
what are some side effects of calcium channel blockers? (TQ)
1. negative inotropic effect
2. depression of existing sick sinus syndrome
3. AV nodal disease
4. hypotension
5. dizziness
6. flushing
7. Verapamil causes constipation in the elderly
4 contraindications for calcium channel blockers?
1. hypotension
2. sinus bradycardia
3. AV conduction defects
4. severe cardiac failure
Uses for calcium channel blockers
Acute Myocardial Ischemia
Hypertension
Hypertensive Emergencies
Supraventricular Arrhythmias
sick sinus syndrome is a contraindication for ___
beta blockers
contraindications for calcium channel blockers
hypotension
severe heart failure
sinus bradycardia
AV conduction defects
what drugs can cause a heart block?
beta blockers and calcium channel blockerse
which calcium channel blockers work more like nitroglycerin and which work more like propanolol?
diltiazem and verapamil work like beta blockers

nifedipine works more like nitroglycerin
what kind of arrhythmias can beta blockers treat?
supraventricular
PVCs
what kind of arrhythmias can calcium channel blockers treat?
supraventricular arrhythmias
how does NO relax VSM?
PKG
phosphorylate MLCK
p'lates MLC
p'lates phospholambin activating SERCA
p'lates K channels opening them and causing hyperpol and less calcium influx
p'lates IP3 receptor and decreases Ca release from the ER
what drug stimulates preconditioning?
nitroglycerin
how is resistance to NTG caused?
something about glutathione