Reading...
Play button
Play button
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;
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
2.prinzemetals |
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 |
|
|
Nitrates
|
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 |
|
|
Isosorbide
|
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
|
(Dihydropyridines)
Nifedipine--no AV delay--does not affect the rate of recovery of the slow Ca2+ channel amlodipine, felodipine, isradipine, nicardipine, nisoldipine, and nimodipine |
|
|
Abciximab
Tirofiban Eptifibitide |
Anti-integrin agents directed against the platelet integrin GPIIb/IIIa (including abciximab, tirofiban, and eptifibitide) are effective in combination with heparin
|
|
|
Bepridil
|
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
|
Diltiazem
Nifedipine amlodipine felodipine |
