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35 Cards in this Set
- Front
- Back
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primary symptom of ischemic heart disease
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angina pectoris
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drugs that decrease O2 demand
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b-blockers, organic nitrates, CCB
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drugs that increase O2 supply
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vasodilators, CCB, statins, anti-thrombotics
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causes an increase myocardial O2 supply
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coronary vasodilation
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difference between stable and unstable angina
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platelet aggregation/thrombus formation
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focal or diffuse coronary vasospasm espisodically reducing coronary flow
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variant angina
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rupture of an atherosclerotic plaque, with consequent platelet adhension, and aggesgation, decreases coronary blood flow
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unstable angina
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ischemia without pain
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silent ischemia
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ischemic chest pain occurs at characteristic workloads
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stable angina
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clinical manifestation of chronic CAD
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angina pectoris
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organic nitrates, B-blockers, CCB treat
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mycardial ischemia
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given sublingual and transdermal to avoid first-pass metabolism for rapid absorption
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nitroglycerin
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once absorbed, unchanged, will have T 1/2 of 2-8 min
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Nitroglycerin
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provides most of therapeutic effect of orally administered nitroglycerin
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dinitro derivatives
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active metabolite of isosorbide dinitrate, given orally (not activated in the liver)
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isosorbide 5-mononitrate
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vascular smooth muscle relaxation, vasodilation
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NO
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activates NO
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guanylyl cyclase
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activated NO by guanylyl cyclase increases
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cGMP
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increase in cGMP activates
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PKG
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causes inactivated MLCP to become activated to cause relaxation
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cGMP
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decrease preload, resulting in decresed myocardial O2 demand
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organic nitrates
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mildly dilate arteriolar resistances vessels, with resulting decr. afterload and decr. myocardial O2 demand
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organic nitrates
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caused by increase in dilation of large epicardial arteries
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increased myocardial O2 supply
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organic nitrates exert majority of their vasodilator action by
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dilating venous capacitance vessels
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ADR: venous pooling, reflex tachy, decrease BP, decr. CO, incr. coronary blood flow at HIGH doses
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organic nitrates
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ADR: throbbing HA from dilation of arterial vessels, orthostatic hypotension, tachy in LOW doses
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organic nitrates
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compensatory sympathetic NS response (reflex incr. in sympathetic vasc tone) & compensatory renal responses (Na+/H2O retention)
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physiologic tolerance
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diminished clinical efficacy due to continued exposure
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pharmacologic tolerance
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contraindicated in organic nitrates
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glaucoma, incr. ICP, phosphodiasterase-5-inhibitors
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sildenafil contraindicated with organic nitrates because
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sildenafil also incr. cGMP = cause extreme vasodilation (low BP)
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IV nitrate administration recommended for 48 hrs for
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acute MI
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1st line tx in pulmonary hypertension associated with ischemia and ventricula dysfunction
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nitroglycerin
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tx uterine hypertonous, manage perioperative HTN, induce hypotension
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nitroglycerin
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classical DHP
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nifedipine (Adalat)
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bind to L-type calcium channels, reducing the frequency of opening in response to depolarization
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CCBs
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