Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
|
What factors affect the demand of the heart and how can you use these to help with angina?
|
Ventricular wall stress (preload and afterload): dilate to help
HR, dec to help Contractility, dec to help |
|
|
What are the 3 types of angina?
|
Stable: Predictive pain pattern
Unstable: Changes, MI! Printzmetal's or Variant: Vasospastic <-- Use DHP-CCB's |
|
|
What is the MOA of Calcium channel blockers?
|
Inhibit Ca through L-type channels in HEART and VASCULAR SM.
Cardiac: neg inotropy, neg AV conduction, SAN depression Vascular: dilate vessels to decrease afterload |
|
|
What kinds of CI do they have compared to beta-blockers?
|
NOT CI in asthma, chronic bronchitis, peripheral arterial dz, diabetes UNLIKE beta blockers
|
|
|
What are the actions of calcium channel blockers related to angina?
|
Coronary relaxation (good for coronary vasospasms)
Arteriolar dilation, decrease afterload Negative inotropy (not as much for dihydropyridines-vascular) -- can be CI in HF! |
|
|
What are the toxicites of calcium channel blockers?
|
HA, flushing (vasodilation)
Increased urination due to increased Ca in bladder muscle (Inappropriate cardiac- cardiac arrest, heart block, CHF- and vascular effects- postural hypotension, edema) |
|
|
What are the dihydropyridines? What is their MOA
|
(pines) Nifedipine (reflex tachycardia and gum hypertrophy), Amlodipine (best), Nicardipine
Also Felodipine, Isradipine Vascular specific Calcium channel blockers |
|
|
What are the effects of dihydropyridines?
|
Inc HR (reflex tachycardia)
Dec BP! vascular effects <-- cause the greatest decrease in BP versus other CCB's Inc CO (no cardiac effects really) Cause ankle swelling bc peripheral dilation |
|
|
What is the name of the phenylalkamine? What is its MOA?
|
Verapamil -- CCB. Cardiac specific!
Causes neg inotrop, dec AV conduction, SAN depression Dec HR-- cardiac some dec BP (slightly vascular) no change in CO (effects cancel) |
|
|
What is the use of verapamil?
|
Arrhythmias! BC blocks AVN conduction!
|
|
|
What is the AE of verapamil?
|
CCB's AE and CONSTIPATION! (vera wang wears wedding dresses to hide her constipation?)
|
|
|
Where are verapamil and diltiazem CI? What kinds of drug interactions does verapamil have?
|
Heart failure! (neg inotropy)
Heart block and bradycardia (affects both nodes) Beta blockers -- excessive negative inotropy Digoxin/Digitalis -- increases concentration of digoxin Note: they do not cause reflex tachycardia bc they depress the SAN and neg inotropy but may be CI in heart problems |
|
|
Name the benzothiazepine. What is its MOA?
|
Diltiazem - CCB with vascular and cardiac intermediate effects
Dilation in coronaries and arterioles Neg inotropy, dec AVN conduction, SAN depression |
|
|
What is the "anti-platelet" used for angina? What is its MOA?
|
Aspirin! Irrev inhibition of COX-1 and COX-2.
Anti-platelet, anti-pyretic, analgesic = without pain, anti-inflammatory |
|
|
Where should you use aspirin?
|
Improve risk of survival post-MI and reduce risk of MI in stable/unstable angina
Reduce stroke in cerebral TIA Reduce thromboembolism in pts with atrial fib and after valve replacement |
|
|
When is aspirin NOT used?
|
Prophylaxis because of AE of bleeding
|
|
|
What are the nitrates used in angina?
|
Nitroglycerin
Isosorbide Dinitrate and Isosorbide Mononitrate Erythrityl tetranitrate, Pentaerythitol tetranitrate |
|
|
How is nitroglycerin administered?
|
Sublingual tablets, aerosol
Transdermal (patch instead of ointment) Oral (1st pass effect) IV for periop HTN, CHF, severe angina, pulmonary edema assoc with acute MI |
|
|
How should nitrates be stored?
|
In amber bottles, protect from light and moisture
|
|
|
What is the MOA of nitrates?
|
Release of NO.
Nitroglycerin is metabolized to glutathione S-transferase in SMCs t NO Intermediate step requires sulfhydryl groups! |
|
|
Why do you need a 10-12 hour nitrate free interval?
|
TOLERANCE!
depletes sulfhydryl groups required for activation |
|
|
What 2 enzymes does NO stimulate and what are their effects?
|
Stimulates guanylyl cyclase to increase cGMP, sequesters free Ca in SM -- relaxation (endothelium-independent mechanism)
Stimulates guanylate cyclase to inhibit platelet function |
|
|
What are the 3 hemodynamic effects of nitrates?
|
Vascular SM relaxation (more venous, IV/high dose for arterial)
Coronary blood flow improvement Non-vascular SM relaxation |
|
|
What is the use of nitrates in angina?
|
Acute symptomatic relief of stable and unstable -- sublingual (but does NOT help with mortality-- beta blockers do)
Acute prophylaxis - sublingual Long-term prophylaxis (tolerance!) - slow release, transdermal |
|
|
What are the toxicities of nitrates?
|
HA (common! bc meningeal artery vasodilation)
Hypotension - esp with PDE-5 inhibitors Tachyphylaxis with tolerance! (stop dosing at night) |
|
|
What drug should you avoid when taking nitrates?
|
PDE-5 inhibitors (for erectile dysfunction)
|
|
|
When should you use isosorbide dinitrate and mononitrate? Which has better bioavailability and a longer half life?
|
Mono > Di > Tri
Good for oral prophylactic use, esp long-term |
|
|
What four beta blockers are used in angina? Which are selective and nonselective? Which has lipid solubility?
|
Atenolol, metroprol, propanolol, nadolol
Atenolol, metoprolol - selective lipid solubility: propanolol These do not have intrinsic sympathetic activity so can be used to dec HR and red BP |
|
|
How is propanolol metabolized? Why is it not used for angina?
|
CYP2D6 metabolism - needs constant dosing
Nonselective, so worse AE |
|
|
How are atenolol and metoprolol better for angina versus propanolol and how are they excreted/metabolized?
|
Selective, better with dosing
Atenolol- unchanged by kidneys Metoprolol- inactivated by hepatic metab |
|
|
What is the MOA of beta blockers?
|
Block G proteins linked with adenyl cyclase, decrease cAMP, decrease beta receptor actions
Decrease HR, decrease contractility |
|
|
What are the uses of beta blockers in angina?
|
Angina prophylaxis
Reduce risk of sudden death or reinfarction after MI (with aspirin) NOT vasospastic angina (bc unopposed alpha receptors) NOT tx acute angina (unlike nitrates) |
|
|
What are the toxicities/CI of beta blockers?
|
Obstructive airway dz worsened
Heart block Peripheral vascular dz, Raynaud's Diabetes (masks hypoglycemia) Get REBOUND angina after abrupt stop CNS if lipophilic (dizziness, fatigue, depression, lethargy, dreams) IMPOTENCE, wheezing, dyspnea |
