Crr Week 5: Anti Anginal Drugs (Blair)

Front 1

Which portions of the heart are supplied by the Circumflex artery?

Back 1

1. Left atrium
2. Side/back of left ventricle

Front 2

Which portions of the heart are supplied by the Left anterior descending artery?

Back 2

1. Front/bottom of left ventricle
2. Front of the septum

Front 3

Which portions of the heart are supplied by the Right coronary artery?

Back 3

1. Right ventricle
2. Bottom portion of left ventricle
3. Back of the septum

Front 4

List 4 factors that influence coronary blood flow.

Back 4

1. Heart rate
2. Contractility
3. Preload
4. Afterload

Front 5

Define angina pectoris.

Back 5

Discomfort or pain associated with an imbalance between myocardial oxygen supply and demand

Front 6

How is the experience of angina in women different than that experienced by men?

Back 6

Women usually have an "atypical" presentation of anginal pain:

1. May have no sensations from chest, instead --> jaw, neck, shoulders, back
2. Chest sensation may full, sharp, stabbing, or burning pain
3. Pain is longer, more severe, more frequent

Front 7

What is the usual cause of stable angina?

Back 7

Atheromatous lesion

Front 8

What is the usual cause of unstable angina?

Back 8

Rupture of atherosclerotic clot

Front 9

What is the effect of nitrates at low therapeutic doses?

Back 9

Venous smooth muscle relaxation
(increases venous capacitance)

1. Lower venous return --> lower preload
2. Lower wall tension --> lower O2 demand
3. Lower stroke volume --> lower cardiac output

Front 10

What is the effect of nitrates at high therapeutic doses?

Back 10

Arterial smooth muscle also relaxes
(reducing total peripheral resistance)

Front 11

Do nitrates directly influence coronary blood flow by dilating the vasculature?

Back 11

No.
(flow is not changed)

Front 12

What are nitrates typically used to treat?

Back 12

1. Stable angina
2. Variant angina
3. Unstable angina

Front 13

Nitrates are contraindicated in which patients?

Back 13

Those taking PDE5 inhibitors

Front 14

Which specific channel do the Ca2+ channel blockers work on?

Back 14

Voltage-gated L-type slow Ca2+ channels

Front 15

What type of drug is Bepridil?

Back 15

Ca2+ channel blocker
(similar to Verapamil)

Front 16

Which drug is similar to Verapamil, but more effective at blocking Na+ channels?

Back 16

Bepridil

Front 17

What is an adverse side effect of Bepridil?

Back 17

Increases AV nodal refractory period, which may lead to torsades de pointes

Front 18

Bepridil is prescribed to patients in what circumstance?

Back 18

When the patients don't respond to other drugs

Front 19

What is the effect of all calcium channel blockers?

Back 19

Reduce myocardial O2 demand

Front 20

Which types of angina are Ca2+ channel blockers effective for?

Back 20

1. Stable angina
2. Variant angina

(Not very good for unstable angina, unless stability is due to vasospasm)

Front 21

List 2 adverse effects of Ca2+ channel blockers?

Back 21

1. Hypotension
2. Headache

Front 22

What is the main adverse effect of nitrates?

Back 22

Hypotension/ orthostatic hypotension

Front 23

What is the MOA of beta blockers?

Back 23

Block B1 adrenergic receptors

1. Decrease heart rate
2. Decrease contractility
3. Decrease AV conduction speed

Front 24

How do beta blockers increase myocardial blood supply?

Back 24

They cause longer periods of diastole, allowing more blood flow

Front 25

Beta blockers are effective treatments for which heart conditions?

Back 25

1. Stable angina
2. Unstable angina
3. Silent ischemia

(Not good for variant agina)

Front 26

What is the major adverse effect of beta blockers?

Back 26

Congestive heart failure

Front 27

For which conditions are beta blockers contraindicted?

Back 27

1. Asthma
2. Bronchospasm

Front 28

List 3 drug combinations for treating agina.

Back 28

1. Nitrates + B-blockers
2. Nitrates + B-blockers + Ca2+-channel blockers (dihydropyridines)
3. Nitrates + Ca2+-channel blockers

Front 29

What is the MOA of erectile dysfunction drugs?

Back 29

Inhibit PDE5, prolonging the action of cGMP.

Front 30

List two ED drugs.

Back 30

1. Sildenafil (Viagra)
2. Alprostadil (Caverject)

Front 31

ED drugs are contraindicated when a patient is taking which other medications?

Back 31

1. Nitrates
2. alpha-adrenergic antagonists

Front 32

How is Alprostadil administered?

Back 32

1. Injected into cavernosal tissue
2. Placed into urethra as a minisuppository

*Phentolamine can also be injected into cavernosa to produce erections

Front 33

NO causes guanylyl cyclase to convert GTP to cGMP, which then activates PKG. List 5 structures that PKG phosphorylates to cause vasodilation

Back 33

1. L-type Ca2+ channel
2. Ca2+-ATPase
3. Ca2+ dependent K+-channel
4. Phospholamban
5. Phosphatase

Front 34

List the steps to the molecular pathway that are blocked by Beta-blockers.

Back 34

B1-receptor inhibition, blocks the following events:
1. Adenyl cyclase conversion of ATP --> cAMP
2. cAMP activation of PKA
3. PKA phosphorylation of L-type Ca2+ channel and Ryanodine receptor
4. Ca2+ influx into cytoplasm from extracellular space and from SR

Front 35

What is the function of PDE5?

Back 35

PDE5 converts cGMP --> 5'-GMP
(disabling the action of cGMP, decreasing vasodilation)

Front 36

Atheromatous plaques most commonly occur within which portions of the coronary arteries?

Back 36

Within the first few centimeters of any of the coronary arteries
(most proximal portions)

Front 37

When does most of the blood flow in the left coronary artery occur (systole/diastole)?

Back 37

Diastole
(compression of left ventricle during systole produces a force greater than the arterial pressure in the L coronary artery)

Front 38

When does most of the blood flow in the right coronary artery occur (systole/diastole)?

Back 38

Systole
(pressure in the aorta is greater than right ventricle)

Front 39

Coronary blood flow is proportional to....?

Back 39

Myocardial oxygen demand

Front 40

What are the 4 factors that determine myocardial oxygen demand?

Back 40

1. *Preload (diastolic wall tension)
2. *Afterload (systolic wall tension)
3. Heart rate
4. Contractility

Front 41

How do nitrates relax smooth muscle cells?

Back 41

Smooth muscle cells enzymatically convert nitrates to nitric oxide, which relaxes the cells through the guanylyl cyclase system

Front 42

What is the primary hemodynamic effect of nitrates that relieves angina?

Back 42

Increase in venous compliance with resultant decrease in myocardial oxygen demand