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24 Cards in this Set
- Front
- Back
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metabolic vasodilators (5)
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adenosine
lactate acetate H+ CO2 |
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endothelial vasodilators (3)
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NO
prostacyclin EDHF |
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endothelial vasoconstrictor (1)
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Endothelin 1
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EKG on stable angina
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temporary depression of ST segment without permanent damage
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EKG on variant angina
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transient shift in ST segments (usually ST elevation)
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dipyridamole
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an arteriolar dilator that can worsen angina
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signal transduction of nitrates (5)
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increased nitrates --> increased NO --> increased cGMP --> dephosphorylation of myosin light chain --> vascular smooth muscle
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Contraindications of nitrates (3)
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Liver failure patients
patients taking phosphodiesterase inhibitors (PDE inhibitors prevent the breakdown of cGMP thus prolonging the effects of nitrates leading to hypotensive shock) concurrent use of migraine medication may increase BP and decrease effects of nitrates |
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ultra short nitrates
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last 3-5mins
inhaled amyl nitrate |
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short nitrates
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last 10-30mins
sublingual nitroglycerin (glyceryl trinitrate) isosorbide dinitrite |
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intermediate nitrates (3)
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4-8 hrs (therapeutic effect is mainly due to active metabolites)
oral or sustained release nitroglycerine isosorbide ninitrate isosorbide mononitrate |
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long nitrates (2)
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8-10hrs (blood levels may persist for 24 hours but tolerance limits duration of action)
transdermal nitroglycerine patch oral-extended release mononitrate become useful when the number, severity, and duration of angina attacks increase |
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nifedipine
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dihydropyridine type calcium channel blocker (preferentially acts on vascular channels)
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bepiridil
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dihydropyridine type calcium channel blocker (preferentially acts on vascular channels
blocks both Na and Ca channels used in chronic angina; not a first line drug |
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bepiridil side effects (3)
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heart failure when combined with beta blockers
torsades and other arrhythmias agranulocytosis |
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verapamil
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phenylalkylamine type calcium channel blocker (preferentially acts on cardiac channels)
used om stable and variant angina do not combine with beta blockers |
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verapamil side effects (6)
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constipation and gingival hyperplasia
sinus bradycardia high doses can cause myocardial depression, heart failure, edema, headache, and depression |
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diltazem
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benzothiazepine type calcium channel blocker (block both cardiac and vascular channels)
used in stable and variant angina |
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diltazem side effects (4)
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sinus bradycardia
AV block --> heart failure in combination with beta blockers hypotension edema |
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treatment of angina in patient with recent MI
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long acting nitrate
beta blockers |
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treatment of angina in patient with asthma or COPD
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long acting nitrate
calcium channel blockers |
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treatment of angina in patient with hypertension
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beta blockers
calcium channel blockers |
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treatment of angina in patient with diabetes
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long acting nitrate
calcium channel blocker |
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treatment of angina in patient with chronic renal disease
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long acting nitrate
calcium channel blockers |
