Pharm-Exam3-Scar-Angina-Cvo

Front 1

angina pectoris is chest pain due to ___

Back 1

inadequate coronary blood flow

Front 2

cause of angina pectoris

Back 2

atherosclerosis of coronary vessels

Front 3

Tx for angina pectoris

Back 3

surgery to improve coronary blood flow drugs that reduce myocardial O2 requirement

Front 4

hearts uses ___% of available O2 at rest

Back 4

75%

Front 5

normally, when you excercise coronary blood flow goes up to meet the heart's O2 demand, but in angina what happens?

Back 5

atherosclerosis of coronary artery reduces available O2 leading to chest pain

Front 6

3 determinants of myocardial oxygen demand are:

Back 6

1. myocardial wall stress 2. heart rate 3. heart contractility

Front 7

let's talk about myocardial wall stress as it relates to myocardial oxygen demand

Back 7

afterload - heart must overcome arterial blood pressure to eject blood...therefore elevated aBP can increase wall stress prelaod -- increased venous BP returns more blood to heart...if you increase ventricular volume you get wall stress wall thickness - increased ventricular tension means myocytes grow, needing more O2, which isn't going to come

Front 8

HR and contractility as it relates to O2 demand

Back 8

faster and harder = need more O2

Front 9

there are 3 groups of antianginal drugs...what are they and what do they all do?

Back 9

1. nitrates/nitrites 2.Calcium channel blockers 3. beta adrenoceptor blockers all reduce O2 demand, making the heart's job easier

Front 10

nitrates/nitrites decrease BP how?

Back 10

dilate peripheral arteries and veins

Front 11

calcium channel blockers do what?

Back 11

peripheral dialation reducing HR, BP, contractility

Front 12

beta adreno blockers do what?

Back 12

reduce HR and contractility

Front 13

nitrates/nitrites get converted to ___, which causes the effects

Back 13

NO

Front 14

what happens if you give nitrates/nitrites orally?

Back 14

quickly inactivated via first pass effect therefore sublingual admin avoids first pass effect last about 15 min

Front 15

primary target of nitrates and nitrites

Back 15

vascular smooth muscle causing relaxation of arteries and veins

Front 16

primary direct result of nitrates and nitrites

Back 16

decrease ventricular preload

Front 17

so nitrates and nitrites cause vasodilation leading to what?

Back 17

leading to decreased preload, then decr CO and decr O2 demand

Front 18

NO favors ___ ___

Back 18

muscle relaxation

Front 19

2 examples of nitrates/nitrites used to treat angina

Back 19

nitroglycerine and amyl nitrie

Front 20

toxicities of nitrates and nitrites

Back 20

hypotension, reflex tachy, fainting, headache sex enhancers (bad?)

Front 21

nitrates/nitrites decrease what? calcium channel blockers decrease what? beta adreno blockers decrease what

Back 21

nitrates = decr BP calcium blockers = decr BP, HR, contractility beta adreno blockers = decr contractility and HR

Front 22

what channels are blocked by calcium channel blockers

Back 22

L-type calcium channels....preventing influx of calcium which inhibits muscle contraction

Front 23

first L-type calcium channel blocker

Back 23

verapamil followed by nifedipine and diltiazem

Front 24

first L-type calcium channel blocker decrease ___

Back 24

decrease depol induced channel opening

Front 25

overdose of calcium channel blockers can lead to ___ __

Back 25

cardiac arrest

Front 26

in pacemaker myocytes what currents exist

Back 26

no Na current Calcium channels have biggest effect via L-type calcium channels

Front 27

funny channels are an important part of pacemaker activity in the ___ node

Back 27

SA

Front 28

in normal individuals the HR is dicated by ___ which occurs in what phase?

Back 28

dictated by SA node in phase 4

Front 29

tell me about how beta adreno blockers work?

Back 29

so, normally, NE binds to beta 1 receptors causing increase cAMP, increased funny channel activty, PKA activation, which phosphorylates L-type calcium channels activating them...leading to incr HR beta blockers block this entire process at the start, reducing HR

Front 30

how do beta blockers reduce contractility

Back 30

prevent calcium influx thru L-type calcium channels

Front 31

most beta blockers are pure ___

Back 31

antagonists

Front 32

Catecholamines activate the PKA pathway in atrial and ventricular myocytes L-type Ca2+-channels are opened, Ca2+ enters, and CICR amplifies the signal More Ca2+ is made available to contractile machinery, which strengthens contraction

Back 32

Beta-blockers decrease these effects by decreasing Ca2+ entry

Front 33

beta 2 blockade

Back 33

constricts brochioles = problem