Pharm - Yr2, Sem1, Block 1 - Anti Anginals

Front 1

3 things that determine myocardial oxygen demand

Back 1

1. wall stress
2. HR
3. contractility

Front 2

Wall stress equation

Back 2

Pr/2h

Front 3

Profusion pressure happens during?

Back 3

diastole

Front 4

hypoxia in myocardium leads to formation of which vasodilators?

Back 4

1. ADENOSINE
2. lactate
3. acetate
4. H+
5. CO2

Front 5

variant angina is due to?

Back 5

coronary artery spasm

Front 6

stable angina

Back 6

1. chronic
2. exertion
3. transient changes in EKG

Front 7

stable angina shows what on EKG?

Back 7

Temporary ST depression

Front 8

Variant angina ( Prinzmetal)

Back 8

1. at rest
2. morning
3. ST elevation

Front 9

When does prinzmetal angina usually occur?

Back 9

At rest in the morning.

Front 10

A pattern of increased frequency and duration of angina describes what type of angina?

Back 10

unstable angina

Front 11

what type of angina has unopposed vasoconstriction?

Back 11

unstable angina

Front 12

stable angina Tx strategies?

Back 12

1. increase O2 supply, reduce O2 demand
2. Tx artherosclerosis
3. prophylaxis against thrombosis

Front 13

drug classes of anti anginals?

Back 13

1. Nitrates
2. Beta blockers
3. calcium channel blockers

Front 14

name 4 organic nitrates

Back 14

1. Glyceryl trinitrate
2. Isosorbide dinitrate
3. isosorbide mononitrate
4. Amyl nitrite

Front 15

which nitrate drug is used to Tx cyanide poisoning?

Back 15

amyl nitrate

Front 16

amyl nitrite and __________
is used to Tx cyanide poisoning?

Back 16

methylene blue

Front 17

Uses of nitrates

Back 17

1. acute angina
2. prophylaxis
3. Beta blocker intolerance
4. Ca channel blocker intolerance
5. cyanide poisoning

Front 18

MOA of amyle nitrite and methylene blue?

Back 18

amyle nitrite converts hemoglobin to methemoglobin. Cyanide binds methemoglobin and methylene blue reduces the methemoblobin and gets rid of the cyanide.

Front 19

Nitrates therapy does what?

Back 19

vasodilates
1. venules >> arterioles
2. coronary arteries
3. inhibits platelet aggregation

Front 20

Which medication worsens an angina attack by increasing coronary steal?

Back 20

dipyrimadole. It dilates the normal arteries.

Front 21

This shows the action of which drug?

Back 21

nitrate. Nitrates dilate the collaterals and increase blood flow to the ischemic area.

Front 22

nitrates increases _________ in the cell and leads to smooth muscle _________?

Back 22

increases cGMP and smooth muscle dilation

Front 23

phosphodiesterase 5 does what?

Back 23

It breaks down cGMP to GMP.

Front 24

Inhibition of PDE 5 will cause?

Back 24

Increase in cGMP and vasodilation

Front 25

adverse effects of nitrates?

Back 25

1. flushing
2. headache
3. orthostatic hypotension
4. reflex tachycardia
5. syncope
6. methemglobinemia

Front 26

Large IV doses of nitroglycerine can cause?

Back 26

methemglobinemia

Front 27

Describe Monday Morning sickness?

Back 27

workers in explosive factories got used to nitrate exposure but after a weekend of being nitrate free, on Monday they got headaches.

Front 28

Way to not develop tolerance to therapeutic effects of nitrates?

Back 28

nitrate free interval in the night.

Front 29

Combining nitrates and _______ can lead to hyptensive shock?

Back 29

PDE inhibitors b/c they prevent breakdown of cGMP and prolong effects of nitrates.

Front 30

What medication decreases effects of nitrates?

Back 30

migraine meds

Front 31

Which nitrate type is most potent and has the longest half life?

Back 31

trinitrates.

Front 32

Which nitrate type is the least potent and has the longest half life?

Back 32

mononitrate

Front 33

which nitroglycerin formulation has the shortest onset and shortest duration?

Back 33

sublingual

Front 34

which nitrate has the shortest onset of action?

Back 34

inhaled amyl nitrite

Front 35

For long term angina prescribe which nitrate formulation?

Back 35

ISDN, ISMN

Front 36

What do have to tell pt's about their nitrate meds?

Back 36

1. volatile- keep in cool, dry place
2. 6 months- after that they are not good.

Front 37

Stable angina - Beta blockers

Back 37

1. reduce work load
2. stop reflex tachycardia.

Front 38

Stable angina-Beta blockers Side effects

Back 38

1. bradycardia
2. bronchospasms
3. fatigue
4. depression
5. rebound HTN

Front 39

Beta blockers in diabetic pt

Back 39

Masks hypotension.
Sweating is only sign.

Front 40

Beta blockers side effects
if pt incurs bronchospasms what should you do?

Back 40

switch to B1 selective

Front 41

name 3 L-type calcium channel blockers?

Back 41

1. Nifedipine
2. Verapamil
3. Diltiazem

Front 42

Nifedipine blocks?

Back 42

vascular L-type Ca channels

Front 43

Verapamil blocks?

Back 43

cardiac L-type Ca channels

Front 44

Diltiazem blocks?

Back 44

cardiac and vascular L type Ca channels

Front 45

calcium channel blockers therapeutic effects in stable angina?

Back 45

1. decrease contractility
2. cause venodilation
3. increase coronary perfusion

Front 46

Nifedepine

Back 46

1. Variant angina
2. reduces Preload, afterload
3. S/E constipation, gingival hyperplasia.

Front 47

Bepiridil

Back 47

1. blocks Na and Ca channels
2. used for Chronic stable angina
3. S/E heart failure when used w/ Beta blockers

Front 48

Bepiridil plus Beta blockers causes heart failure by?

Back 48

slowing AV conduction

Front 49

Verapamil

Back 49

1. V for Ventricle
2. stable angina, variant angina
3. Slows AV conduction
4. DONT COMBINE W/ BETA BLOCKERS
5. DONT USE AFTER MI

Front 50

Verapimil S/E ?

Back 50

1. constipation
2. gingival hyperplasia

Front 51

Diltiazem

Back 51

1. stable and variant angina
2. mixed properties
3. S/E bradycardia

Front 52

Tx for Variant Angina?

Back 52

1. Nitrates
2. Calcium channel blockers

Front 53

MI and angina Tx?

Back 53

nitrates and beta blockers

Front 54

asthma and angina Tx?

Back 54

nitrate and calcium channel blocker

Front 55

diabetes and angina Tx?

Back 55

nitrate and calcium channel blocker

Front 56

chronic renal disease and angina?

Back 56

nitrate and calcium channel blocker

Front 57

Acute coronary syndrome

Back 57

1. emergent
2. usually followed by MI
3. occur in pt w/ CAD
4. Use Beta blockers, nitrate, morphine

Front 58

Clopidogrel - (Plavix)

Back 58

1. Antiplatelet drug

Front 59

ACS management

Back 59

1. beta blockers
2. nitrates
3. morphine
4. Clopidogrel
5. Possible PCI or CABG

Front 60

ACS management. Opioids are used for?

Back 60

1. reduce pain
2. decrease SNS activation (CNS effect)

Front 61

name a more potent anti platelet agent?

Back 61

GPIIB/IIIa

Front 62

ACS STEMI use ?

Back 62

thrombolytics

Front 63

Post ACS management?
Short term

Back 63

1. clopidogrel, GPIIb/IIIa
2. anti arrythmics

Front 64

Post ACS management?
Long term

Back 64

1. Risk factors
2. ACE inhib
3. Beta blockers
4. antiplatelets
5. Statins