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30 Cards in this Set
- Front
- Back
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Nitrates in ischemic heart disease are indicated for what?
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All anginas chronically, acute MI.
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What is the mechanism of action for nitrates in ischemic heart disease?
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Increase NO by activating guanylyl cyclase, increasing levels of cGMP. Leads to vasodilation.
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Nitrates cause vasodilation in what set of vessels, preferentially?
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Veins
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What is the primary mechanism of relief of nitrates in angina pectoris?
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Decrease in myocardial work produced by periferal vasodilation.
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What are the four routes of administration of nitroglycerin?
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Sublingually, orally, topically, IV
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What are the two routes of isosorbide dinitrate?
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Orally, sublingually
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What are the side effects of nitrates?
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Vasodilatory: headache, dizzy, lightheaded, syncope, flushing.
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What drugs, when combined with nitrates, produce detrimental effects?
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Drugs used to treat erectile dysfunction, such as Viagra, which inhibit the breakdown of cyclic GMP.
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What is the effect when nitrates are combined with drugs used to treat erectile dysfunction?
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Profound hypotension and death.
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Continuous doses of organic nitrates leads to what effect?
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Marked attenuation of most of their pharmacological effects.
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What is a clinically effective way to prevent attenuation of nitrates, and what side effects does this treatment cause?
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Interrupted therapy for at least 8 hrs/day, which can also cause rebound increase in angina.
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What are the indications for beta blockers?
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Prevent chest pain in stable/unstable angina; to treat acute myocardial infarction.
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Can beta blockers treat variant angina?
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No.
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What is the mechanism of beta-blockers in myocardial ischemia?
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Prevent the effects of catecholamines--decrease heart rate, contractility, and myocardial oxygen demand accompanied by a decrease in blood pressure.
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What are the beta-blocking agents used in myocardial ischemia?
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Metoprolol
Propanolol |
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What are the organic nitrates used in myocarcial ischemia?
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Nitroglycerin
Isosorbide |
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What are the common side effects of beta blockers in ischemic heart disease?
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bracycardia, hypotension, peripheral vasospasm, claudication, and worsening of heart failure. Makes asthma worse. Impaired hypoglycemia response. Fatigue, lethargy, sleep disturbed.
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What is the most effective category of agents to treat symptoms of coronary artery disease?
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Beta blockers
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Every patient who has had an MI is automatically placed on this category of drugs:
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Beta-blockers
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What is the most common reason for people to discontinue taking beta-blockers?
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Sexual dysfunction, fatigue.
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What are the three calcium channel antagonists used in myocardial ischemia?
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Nifedipine
Diltiazem Verapamil |
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What calcium channel antagonist is a potent vasodilator?
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Nifedipine
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What two calcium channel antagonists are potent suppressors of cardiac contractility and automaticity?
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Diltiazem
Verapamil |
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What is the mechanism of calcium channel antagonists in ischemic heart disease?
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Bind to the alpha 1 subunit of the L-type calcium channels and reduce calcium flux to decrease contractility
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All calcium channel blockers are available orally. Which two are also available as IV?
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Verapamil
Diltiazem |
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What are the side effects of calcium antagonists in ischemic heart disease?
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Hypotension, bradycardia, edema, and worsening of congestive heart failure.
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The use of short acting calcium antagonists such as nifedipine and diltiazem can cause what side effects?
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Marked hypotension with reflex catecholamine release that can worsen ischemia.
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When stable angina is refractory to most standard medications, what medication is indicated?
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Ranolazine
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What is the mechanism of Ranolazine in the treatment of stable angina?
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Unknown. Possible alteration of cardiac metabolism.
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What is the route of administration of Ranolazine?
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Sustained release oral tablets.
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