Chapter 12 Pharm

Front 1

The most common cause of angina is atheromatous obstruction of the large coronary vessels. What is this called? 2 names

Back 1

Effort Angina
Classic Angina

Front 2

Transient spasm of localized portions of large coronary vessels usually associated with underlying atheromas which can also cause sig. myocardial ischemia and pain.

Back 2

Vasospastic or variant angina

Front 3

Another name for variant angina is?

Back 3

Prinzmetal Angina

Front 4

When does the myocardial oxygen imbalance usually occur in classic angina?

Back 4

During exercise

Front 5

In variant angina O2 delivery decreases as a result of reversible coronary _____.

Back 5

Vasospasm

Front 6

Type of ACS that is present when episodes of angina occur at rest and when there is a change in the character, freq., and duration of chest pain as well as precipitating factors in patients with previously stable angina.

Back 6

Unstable Angina

Front 7

You must increase oxygen _____ and decrease oxygen ____.

Back 7

Delivery
Demand

Front 8

Arteriolar tone determines ____ wall stress and venous tone determines ____ wall stress.

Back 8

Systolic
Diastolic

Front 9

The goal of angina drugs is to relax ____ ____ either by increasing cGMP, decreasing intracellular Calcium, stabilizing or preventing depolarization of vascular smooth muscle cell membrane, or increasing cAMP in vascular smooth muscle cells.

Back 9

smooth muscle

Front 10

Drug action in angina is to decrease myocardial ______ requirement.

Back 10

Oxygen

Front 11

In some pt.'s ___ and ____ may cause a redistribution of coronary blood flow and increase oxygen to ischemic tissue. They also increase O2 delivery by reversing coronary artery vasospasm.

Back 11

CCB's and Nitrates

Front 12

The preferred route of Nitroglycerin is this, as it avoids first pass effect.

Back 12

Sublingual

Front 13

____ ____ is an active metabolite of isosorbide dinitrate with 100% bioavailability via the oral route.

Back 13

Isosorbide Mononitrate

Front 14

Nitro relaxes all types of SM regardless of cause of pre-existing tone, has virtually no effect on ___ or ___ muscle.

Back 14

Cardiac
Smooth

Front 15

All vessels respond with Nitro: ____ respond at the lowest concentrations ____ and_____ dilate least.

Back 15

Veins
Arterioles
Sphincters

Front 16

Nitro's primary direct result is marked relaxation of veins with increased ____ capacitance and decreased ventricular _____.

Back 16

Venous
Preload

Front 17

Nitro: pulmonary vascular pressures and heart ___ are significantly reduced.

Back 17

size

Front 18

True or False: Temporal artery pulsations and throbbing headache are common with nitro.

Back 18

True

Front 19

Nitro stimulates guanylyl cyclase increasing cGMP, decreasing ____ aggregation.

Back 19

Platelet

Front 20

FACT: THERE IS NO KNOWN SURVIVAL BENEFIT IN ACUTE MI WITH NITRO

Back 20

FACT

Front 21

Nitro can be used in ____ poisoning as methemoglobin has a high affinity for it.

Back 21

Cyanide

Front 22

______ can be tx.'d by giving methylene blue IV or hydroxycobalaman in treating CN poisoning.

Back 22

Methemoglobinemia

Front 23

Nitro is contraindicated if _____ _____ is elevated.

Back 23

intracranial pressure

Front 24

____ ____ is when a workplace is contaminated with organic nitrate compound, workers suffer HA and dizziness Monday that gradually decreases throughout the week as tolerance develops.

Back 24

"Monday Disease"

Front 25

Nitro effects of Angina: dec. venous return to heart which leads to decreased intracardiac vol., decreased wall tension (Laplace relation) and the MAJOR MECHANISM is a reduction in ____ requirement.

Back 25

Oxygen

Front 26

Nitro effect in variant angina relaxes smooth muscle relieving ____.

Back 26

Vasospasm

Front 27

NitroEffects in Unstable Angina dliates epicardial ___ arteries and reduce ____ demand and decrease ____ aggregation.

Back 27

coronary
oxygen
platelet

Front 28

For severe, recurrent rest angina Transdermal may provide blood levels fir >/=to 24 hrs. but effects don't last more than __ to __ hrs. Nitrate-free period of ___ hrs. is advised to reduce tolerance.

Back 28

6-8
8

Front 29

The two Ca2+ channel blockers used orally and IV are:

Back 29

Verapamil
Diltiazem

Front 30

Calcium Channel blockers decrease Ca 2+ current extends the period of relaxation of smooth muscle and reduces cardiac ____ while decreasing SA and AV node conduction velocities.

Back 30

Contractility

Front 31

Reduction in __ ___ ___ is one mechanism by which CCB's may benefit in angina of effort.

Back 31

Peripheral Vascular Resistance

Front 32

Reduction in coronary ____ tone may benefit in variant angina.

Back 32

artery

Front 33

____ is partially selective for cerebral blood vessels.

Back 33

Nifedipime

Front 34

____ has modest Na+ channel block.

Back 34

Verapamil

Front 35

_____ block SM Ca2+ channels at lower concentrations than they do cardiac calcium channels (Less depressant on the heart)

Back 35

Dihyrdropyridines

Front 36

_____ may reduce mortality after SAH and is used IV and through intracerebral arterial infusion

Back 36

Nicardipine

Front 37

Nifedipime may increase the risk of MI in pt.'s with ____.

Back 37

HTN

Front 38

Calcium channel blockers can increase blood levels of ____.

Back 38

Digoxin

Front 39

CCB's decrease O2 demand by decreasing ___.

Back 39

contractility

Front 40

Verapamil and Diltiazem are the mainstay for ____ and decreasing ventricular response in ___ or ___.

Back 40

SVT
Afib
Aflutter

Front 41

_____ can be used safely in CHF.

Back 41

Amlodipine

Front 42

Immediate-release short acting CCB's are CONTRAINDICATED in UNSTABLE ANGINA but ____ can decrease postinfarct angina in non-Q-wave MI so is not contraindicated.

Back 42

Diltiazem

Front 43

___ ____ are not vasodilators but are useful in effort angina due to ability to decrease HR, BP, and contractility they also decrease O2 requirements at rest and with exercise.

Back 43

Beta-Blockers

Front 44

Beta Blockers decrease mortality in recent ____ and improve survival and prevent ____ in patients with HTN.

Back 44

MI
stroke

Front 45

___ ___ are CONTRAINDICATED in ASTHMA, BRADYCARDIA, AV BLOCK< BRADY-TACHY SYNDROME, UNSTABLE LV FXN. CAN BE balanced with concomitant use of nitrates.

Back 45

Beta Blockers

Front 46

Trimetazidine is a ___ inhibitor that is a metabolic modulator that partially inhibits fatty acid oxidation in myocardium

Back 46

pFox

Front 47

____ reduces contractility due to blockade of late Na current that aids the Na-Ca exchanger

Back 47

Ranozaline

Front 48

___ is a bradycardic drug, a selective If Na+ Channel blocker that reduces heart rate by affecting the SA Node

Back 48

Ivabradine

Front 49

First line tx. of Angina include ___ modification ____ drugs, and ____. ___ ___reduce risk of cardiac events though they may not have anti-anginal effects.

Back 49

Lifestyle
Anti-platelet (ASA, clopidegrel)
Statins
Ace-inhibitors

Front 50

In unstable angina and NSTEMI st___ and ____ drugs and ___ and anti ____ agents

Back 50

stenting
antilipid
Heparin
Anti-platelet

Front 51

Three drugs used in angina of effort that increase time to onset of angina during cardiac stress test.
Exercise tolerance increases but there is no change in angina threshold.

Back 51

Nitrates
BB
CCB

Front 52

For vasospastic angina these two types of drugs are effective but revascularization is NOT indicated.

Back 52

Nitrates and CCB

Front 53

Aspirin, Clopidigrel, Pentoxifylline, Cilostazol (PDE3 inhibitor) are used to treat ___ ___ ___ and Intermittent____ Conventional vasodilators are of no benefit.

Back 53

Peripheral Artery Disease
Claudication