Cv: Drugs For Ischemic Heart Disease

Front 1

When O2 supply can't meet O2 demand, what happens?

Back 1

Ischemia

Front 2

In a pt. with renal heart disease, what is the result of coronary thrombosis/plaque disruption?

Back 2

Unstable Angina

MI

Front 3

In a pt. with renal heart disease, what is the result of Transient Coronary Ischemia?

Back 3

Angina Pectoris

Front 4

This condition is caused by a decrease in coronary blood flow due to vasospasm

Back 4

Variant or Prinzmetal's Angina

Front 5

When does Prinzmetal's angina often occur?

Back 5

at rest or during sleep

Front 6

What do you think will help allevite pain from an attack of Variant/Prinzmetal's angina?

Back 6

Increase O2 supply..

Give a vasodilator like a nitrate. Dilating the coronaries stops vasospasm and alleviates the ischemic pain

Front 7

Stable angina is caused by what disease?

Back 7

Atherosclerosis

Front 8

Explain Stable Angina and exertion.

Back 8

Patient has atherosclerosis.

Upon exertion there is an increase in O2 demand BUT NO INCREASE in blood flow

Front 9

Why is there no increase in O2 supply with exercise in a person with stable angina?

Back 9

B/C the coronary arteries are clogged up..

Front 10

Will arteries with atherosclerotic plaque vasodilate?

Back 10

No

Front 11

Ischemia results from:

Back 11

an increase in O2 demand in the face of a fixed O2 supply

Front 12

What will alleviate the pain from an attack of stable angina?

Back 12

Decrease O2 demand

Front 13

How can you reduce O2 demand?

Back 13

↓HR

↓myocardial contractility

DILATE peripheral arteries & veins

Front 14

What are the tx goals in a patient with Chronic Stable Angina?

Back 14

Prevent MI and Death

↓symptoms of angina and occurrence of ischemia

Front 15

Which type of β Blockers are most effective at treating stable angina?

Back 15

All β blockers are equally effective in treating stable angina

Front 16

MOA: β blockers in Stable Angina

Back 16

Block β1 receptors on heart
↓HR and Contractility
↓O2 demand

Also, ↓BP --> ↓O2 demand

Front 17

What other organs besides the heart are involved with ↓BP with β blockers?

Back 17

Kidneys, Brain (CNS)

Front 18

What is the recommended first line therapy for stable angina?

Back 18

β blockers

Front 19

What are contraindications for use of β blockers for tx of stable angina

Back 19

Heart Block

Heart Failure

Asthma

Front 20

"Nite"

Back 20

Organic Nitrates and Nitrites

Front 21

MOA: low dose Organic Nitrates and Nitrites

Back 21

Release of NO
↓
Dilate Veins
↓
↑Venous capacitance
↓
↓Preload
↓
↓Ventricular EDV
↓
↓Wall tension
↓
↓O2 Demand

Front 22

MOA: high dose Nitrate

Back 22

Dilate arteries
↓
↓PVR
↓
↓ afterload
↓
↓O2 demand

Front 23

Which type of vasculature dilates the easiest?

Back 23

Veins

Front 24

Dilating veins would be beneficial in what type of angina?

Back 24

Stable Angina

Front 25

Can nitroglycerine effectively dilate an atherosclerotic epicardial coronary artery?

Back 25

No

Front 26

**EXAM**

When nitroglycerine is injected directly in the CA of patients with CAD, anginal attacks do not go away

Sublingual nitro relieves pain in these same patients.

What does this tell us?

Back 26

Nitroglycerine is reducing angina by VASODILATING VEINS

**EXAM***

Front 27

The antianginal effect of nitroglycerine can be mimicked with _______

Back 27

phlebotomy

Front 28

**EXAM**

How does nitroglycerine relieve the pain of stable angina?

Back 28

Mainly by ↓ O2 demand by VASODILATING VEINS

**EXAM**

Front 29

What is the MOA for nitrates in VASOSPASTIC Angina?

Back 29

Release of NO
↓
Dilation of Coronary aa.
↓
Relieve Vasospasm
↓
↑O2 Supply

Front 30

Why is hydralazine (arterial VD) not used for stable angina?

Back 30

It aggravates angina and ischemia

**Too much reflex tachycardia**

**Dilation of coronary resistance arterioles** --> Steals blood from ischemic areas

Front 31

How would you administer Nitroglycerine for Unstable Angina or an Acute MI?

Back 31

IV

Front 32

Why use Nitrates in combination with β blockers?

Back 32

β blockers will suppress reflex tachycardia caused by Nitrates.

Front 33

If β blockers can't be tolerated for tx of Stable Angina, what is your next best choice?

Back 33

Nitrates and Nitrites

Front 34

How do you prevent tolerance with chronic use of nitrates?

Back 34

a nitrate-free interval each day

Front 35

What mechanism of nitrates causes acute reactions such as:
Headache
Flushing
Ortho Hypotension
Dizziness
Reflex Tachycardia

Back 35

Vasodilation

Front 36

What types of drugs do nitrates have an adverse interaction with?

Back 36

Erectile Dysfunction Drugs

Front 37

When nitrates are taken with erectile dysfunction drugs, what protein concentration is increased leading to severe hypotension and possible MI?

Back 37

cGMP concentration is increased because erectile dysfunction drugs block PDE-5 which metabolizes cGMP

Front 38

What metabolizes cGMP?

Back 38

PDE-5

Front 39

do DHP CCBs reduce afterload of preload?

Back 39

Reduce afterload

Dilating arteries reduces afterload

Front 40

what will happen to HR with Nifedipine?

Back 40

HR INCREASES d/t reflex tachycardia

Front 41

MOA: DHP CCBs in stable angina?

Back 41

VD arteries
↓
↓Afterload
↓
↓Wall Stress
↓
↓O2 Demand

Front 42

What is the difference between Nifedipine and Non-DHP CCBs?

Back 42

Non-DHP CCBs directly affect the heart AND peripheral vasculature

Front 43

MOA: Non-DHP CCBs in stable angina?

Back 43

↓Afterload
↓
↓Wall Stress
↓
↓O2 Demand

****AND****
↓HR & Contractility
↓
↓O2 Demand

Front 44

MOA: CCBs in Vasospastic Angina?

Back 44

CCBs
↓
Dilate epicardial coronary aa.
↓
↓Vasospasm

Front 45

MOA: Ranolazine

Back 45

Blocks late cardiac Na current
(late I NA channels)

Front 46

Late INA occurs during which phase of the action

Back 46

Phase 2

Late INA channels cause depol

Front 47

How is Late INA related to ischemia?

Back 47

During ischemia there is a peak in Late INA --> Ca++ Overload

Front 48

What does Ca++ Overload do in ischemic myocardium?

Back 48

Increases diastolic wall tension which causes an INCREASED O2 demand

The diastolic wall tension also compresses coronary arteries which REDUCES O2 SUPPLY

Front 49

What is the overall use for Ranolazine?

Back 49

It reduces anginal attacks

It increases excercise intervals

Front 50

This drug causes dizziness, headache, constipation and a prolonged QT interval...

Back 50

Ranolazine

Front 51

How does Ranolazine prolong QT? What is the problem with this?

Back 51

It blocks K+ channels

Potential for cardiac arrythmia

Front 52

Would you prescribe Ranolazine to someone with hepatic dysfunction?

Back 52

NO

Ranolazine is metabolized by CYP450 3A in the liver

Front 53

Should you use CYP450 3A inhibitors along with Ranolazine

Back 53

NO

Ranolazine is metabolized by CYP450 3A