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24 Cards in this Set

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  • Back
patients with what type of angina usually have narrowing of an epicardial coronary artery and ischemia presents upon exertion or stress
stable angina
what typically episodically reduces coronary flow on various occasions to trigger angina or acute MI
coronary artery vasospasm
patients with what type of angina typically have a rupture of an atherosclerotic plaque, with consequent platelet adhesion and aggregation with decreased coronary blood flow
unstable angina
What does Laplace's Law state
the tension (T) in a vessel wall is equal to pressure (P) x radius (r) over vessel wall thickness (mu)
T = Pr/mu
__ induces vascular contraction
Ca
__ induces vascular relaxation
NO
how do nitrates, like nitroglycerin, work
relax smooth muscle in veins at low doses and arteries at higher doses- release NO -> activates guanylyl cyclase -> cGMP -> activates myosin light chain phophatase -> dephosphorylate myosin light chain -> uncouples myosin and actin in smooth muscles (especially venules)
what are the three mechanisms by which organic nitrates relieve angina
1. dilation of venules -> dec prelaod -> increasing coronary blood flow
2. reduced oxygen demand of cardiac muscle by decreasing tension in cardiac walls
3. vasodilate large coronary arteries allowing mechanisms to act and preferentially increase blood flow to inadequately perfused areas with a high concentration of metabolites and ischemia
Name three uses for organic nitrates
angina
CHF
MI
name four contraindications for organic nitrates
patients on sildenafil (all PDE5 inhibitors)
hypotension
hypertrophic obstructive cardiomyopathy
diastolic heart failure
When should organic nitrates be taken; what is the importance of overnight interruptions of dosing
should be taken during anginal attack or in anticipation of exercise or stress

interrupt at night to restore efficiacy- otherwise marked attenuation of responses occurs
why is nitrogylycerin given sublingually
bioavailability low due to high capacity hepatic organic nitrate reductase; sublingual administration avoids first pass effect
what substance is a highly volatile liquid which can be packaged in a glass ampule protected with a cloth covering; and can be crushed to be delivered rapidly via inhalation
amyl nitrite
what organic nitrate is chewable
isosorbide dinitrate
What works on both vascular smooth muscle and myocardium
calcium channel blockers
What are the different calcium channel classifications
T (low threshold)
L
N
P/Q
R
(high thresholds)
which channel is critically involved in both cardiac cells and vascular smooth muscle cells
L type
name three L channel blockers
verapamil and diltiazem
nifedipine
What does Ca normally do in vascular smooth muscle
released from SR -> binds calmodulin -> activates myosin light chain kinase -> phophorylates myosin light chain -> interactions between myosin and actin -> increased strength of contraction and vasoconstriction
name a non selective beta blocker and a beta1 selective blocker
non selective- propranolol
beta1 blocker- atenolol
what type of beta blocker is more useful in treatment of exertional angina
all equally effective
in what type of angina are beta blockers not helpful
vasospastic
name two antiplatelet and antithrombotic agents helpful in angina
aspirin and heparin
nitroglycerin is a donor of ___ that activates guanylyl cyclase to produce ___ leading to relaxation of vasculature
NO
myosin light chain phosphatase