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10 Cards in this Set

  • Front
  • Back
Types of Angina
1. Classic Angina--anginal pain due to inadequate coronary oxygen delivery, on effort/exercise
2. Prinzmetals (vasospastic) reversible e.g. cocaine induced
3. Unstable angina (crescendo) at rest--acute coronary syndrome w/ platelet aggregation
Goals of drug treatments for 1.classic
1.Decrease O2 demand by decreasing PVR, CO or both (Nitrates, CCA's and Beta Blockers)

2.Increase O2 delivery by decreasing the vasospasm w/ nitrates and CCA's
Ca2+ channel blockers, but not nitrates, have been shown to influence mortality and the incidence of MI favorably in variant angina
Activation of NO pathway in endothelial cells via Ach, Bradykinin, Histamine and Serotonin

NO--Guanylyl Cyclase--cGMP--relaxes the vascular smooth muscle (cGMP promotes dephosphorylation of Myosin light chain phosphate--can't interact with Actin)

Dilation of large veins--decreased preload, cardiac work & O2 requirement. Better collateral flow, decreased coronary vasospasm and less platelet aggregation
Decrease infarct size and post MI mortality

High dose: Arteriolar dilation, decreased afterload & oxygen requirement
mono or dinitrate, oral--some extended release--primary initial metabolites, isosorbide-2-mononitrate and isosorbide-5-mononitrate, have longer half-lives (3 to 6 hours) vs. T1/2 40min nitroglycerin
Adverse effects of Nitrates
flushing, headache, orthostatic hypotension (syncope)
Reflex tachycardia and fluid retention
Tachyphylaxis--require rest periods of >12 hrs

combination of sildenafil (Viagra) and other phosphodiesterase 5 (PDE5) inhibitors Tadalafil (CIALIS) and vardenafil (LEVITRA) with organic nitrate vasodilators can cause extreme hypotension
Treatment of Cyanide poisoning
Sodium nitrite or Amyl Nitrite--promote formation of methemoglobin--binds CN- ions--forming cyanomethemoglobin. Prevents CN- interference w/ Complex IV of electron transport chain. Use sodium thiosulfate to convert back to methemoglobin and less toxic SCN- ion
Vascular Selective CCA's

Nifedipine--no AV delay--does not affect the rate of recovery of the slow Ca2+ channel

amlodipine, felodipine, isradipine, nicardipine, nisoldipine, and nimodipine
Anti-integrin agents directed against the platelet integrin GPIIb/IIIa (including abciximab, tirofiban, and eptifibitide) are effective in combination with heparin
CCA (diarylaminopropylamine
Use: only for refractory angina

Bepridil, like verapamil, inhibits both slow inward Ca2+ current and fast inward Na+ current. It has a direct negative inotropic effect.
Slowing of the heart rate, prolongation of the AV nodal effective refractory period, and importantly, prolongation of the QTc interval. hypokalemia-- torsades
Treatment of Raynaud's disease