Pharm Iv

Front 1

How much of the available oxygen does the heart extract during normal conditions?

Back 1

75%

Front 2

what are the 3 drug groups currently approved for the use in angina?

Back 2

nitrates
CCBs
Beta blockers
other:
fatty acid oxidation inhibitors

Front 3

In variant angina, these two may increase myocardial O2 delivery by reversing coronary artery spasm:

Back 3

nitrates and CCBs

Front 4

These are subject to significant first-pass effect by liver:

Back 4

nitrates

Front 5

What is the primary effect of nitrates?

Back 5

venodilation

leads to pooling of blood in veins and reduces preload

Front 6

What is the secondary effect of nitrates?

Back 6

vasodilation

decrease TPR and in turn, MAP and this reduces afterload

Front 7

nitrates activate guanyule cyclase which converts GTP to cGMP. cGMP causes smooth muscle relaxation. What other major effect does cGMP have that may contribute to its effectiveness in treating USA?

Back 7

cGMP decreases platelet aggregation

Front 8

Nitrates can be used safely in glaucoma. Are nitrates CI if ICP is elevated?

Back 8

yes, nitrates are CI if ICP is elevated

Front 9

Nitrates, in combination with what, cause a profound increase in cGMP that can drop BP 25-30mmHg

Back 9

PDE-5 inhibitors

Sildenafil (Viagra)
Vardenafil (Levitra)
Tadalafil (Cialis)

Front 10

Tolerance develops quickly and may be overcome by daily "________-free" intervals

Back 10

nitrates

patches worn 12 on and 12 off

Front 11

Of these three, which are long-acting and used for prophylaxis. Have excellent bioavailability and do not undergo significant 1st pass metabolism. Significant longer half-lives.

Nitroglycerin
Isosorbide Dinitrate (synthetic form)
Isosorbide Mononitrate

Back 11

isosorbide mononitrates

Front 12

the only anti-anginal agents that have been demonstrated to prolong life in patients with CAD post-MI.

Back 12

beta blockers

Front 13

Which non-anti-anginal agents can reduce mortality in post-MI patients, particularly those showing signs of heart failure or low ejection fractions?

Back 13

ACEI

Front 14

considered first-line prophylactic therapy in most patients with chronic stable angina

Back 14

beta blockers

Front 15

Undesirable effects include an increase in EDV and an increase in ejection time. Increased myocardial oxygen requirement associated with increased EDV can partially offset their beneficial effects. These potentially deleterious effects can be balanced by the concomitant use of nitrates.

Back 15

beta blockers

Front 16

These are much less effective and may exacerbate angina in some individuals. Hence, they should be avoided.

Back 16

The ISA beta blockers
(Pinolol, Acebutolol)

Front 17

These are NOT used for variant angina:

Back 17

beta-blockers

Front 18

Avoid abrupt cessation!

Back 18

beta blockers

will have rebound tachy >> rebound hypertension >> increases O2 demand

Front 19

Non-dihydropyridines CCBs block Ca channels in what muscle?

Dihydropyridines block Ca channels in what muscles?

Back 19

Non-dihydropyridines: smooth muscle and cardiac

Dihydropyridines: vasculature

Front 20

amlodipine and nifedipine are examples of what?

Back 20

Dihyropyridine CCB

function mainly as arteriolar dilators and have minimal effects on cardiac contractility and heart rate. Their benefit is mainly causing a decrease in TPR, thereby reducing afterload and myocardial oxygen demand.

Front 21

Not used for acute angina attacks

Back 21

beta blockers, CCBs

Front 22

Relieve and prevent the primary cause of variant angina—focal coronary artery spasm. Use has thus emerged as one of the more effective prophylactic treatments for this form of angina.

Back 22

CCBs

Front 23

These have not reduced mortality post-infarction and in some cases have increased ischemia and mortality rates. Hence, these are considered third-line anti-ischemic drugs in the post-infarction patient.

Back 23

CCBs

Front 24

Although all of the CCBs have been shown to be efficacious for angina, not all preparations and agents are approved for this indication. By and large, ______ and ________ are preferable as first-line agents because they produce less reflex tachycardia.

Back 24

diltiazem and verapamil

Front 25

These should be combined very cautiously w/beta blockers as they can depress sinus node automaticity. Never combine w/AV block pts. May precipitate HF.

Back 25

verapamil and diltiazem

Front 26

most common side effects: H/A, dizziness, facial flushing, edema. These occur less in slow releasing.

Back 26

CCBs

Front 27

constipation is occassionally seen.

Back 27

verapamil

Front 28

best choice:
recent MI

Back 28

long-acting nitrate, BB

Front 29

best choice:
Asthma, COPD

Back 29

long-acting nitrate, CCB

Front 30

best choice:
HTN

Back 30

beta blocker, CCB

Less: long-acting nitrate

Front 31

best choice:
DM

Back 31

long-acting nitrate, CCB

Front 32

best choice:
chronic renal disease

Back 32

long-acting nitrate, CCB

less: Beta blocker

Front 33

According to American College of Cardiology Clinical Guidelines, these should be used as initial prophylactic therapy in absence of CI

Back 33

beta blockers

Front 34

According to American College of Cardiology Clinical Guidelines, this should be used in all pts with CAD who also have DM and/or LV dysfunction

Back 34

ACEI

Front 35

These two are effective for relieving and preventing ischemic episodes in patients with variant angina.
In approximately 70% of patients treated with these two, angina attacks are completely abolished; in another 20%, marked reduction of frequency of anginal episodes is observed
CABG or PTCA are not indicated in patients with variant angina

Back 35

organic nitrates and CCBs

Front 36

unstable angina:
anticoag and antiplatelet play major role.
What are used 1st line and which are also used frequently if not otherwise CI.
CCBs have not shown to favorable affect outcomes and should be used as third-line therapy.

Back 36

The nitrates are first-line anti-ischemic therapy for unstable angina; b-blockers are also frequently a part of the initial treatment unless otherwise contraindicated.

Front 37

Decreases the cardiac muscle cells' ability to use fatty acids as an energy source. Hence, the heart is forced to continually use glucose instead. It takes MORE oxygen to "burn" fatty acids and make ATP than to "burn" glucose to make ATP. So, in essence, this drug is causing the heart to "conserve" its oxygen supply by using glucose. This shift to glucose can then reduce the amount of myocardial oxygen needed to support a given level of cardiac work so that for any level of coronary blood flow, ischemia would be less likely to develop.

Back 37

Ranolazine (Ranexa)