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47 Cards in this Set
- Front
- Back
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what is the main causes of coronary artery disease?
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obstruction of coronary arteries by atheromatous plaques
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what causes angina?
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oxygen demand exceeds supply
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how is angina pain described?
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severe chest pain- strangling, vise like, constricting, suffocating, crushing, heavy, squeezing
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What is the etiology of Classic angina vs. Prinzmetals?
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classic- due to atheromatous obstruction
prinzmetals- spasm of atherosclerotic coronary vessels |
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What does O2 demand in the heart depend on?
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Heart Rate
Myocardial contractility and ventricular wall tension |
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What is coronary blood flow proportional to?
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perfusion pressure
duration of diastole |
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How do antianginal drugs typically work? (two big picture ideas)
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increase O2 supply via vasodilation
decrease O2 demand via reduced cardiac work |
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How do Nitrates cause vasodilation?
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these release a nitrite ion, which turns into nitric oxide. This activates guanylyl cyclase, which increases cGMP in smooth muscle. and relaxes vascular smooth muscle
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What type of vessels does Nitrates generally affect more?
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Large veins have the most dilation (reduced preload)
(arterioles are dilated a little, this decreases afterload) |
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How can nitrates cause negative effects in angina?
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the drop in BP from nitrates can lead to reflexive tachycardia
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What is the predominate relief mechanism of nitrates?
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decrease in O2 requirement due to reduced preload (from dilated veins)
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What is the secondary relief mechanism of nitrates?
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redistribution of coronary blood to ischemic areas, without changing total flow
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What is used to induce methemoglobin in cyanide toxicity?
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sodium nitrite
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How does sildenafil work?
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this inhibits phosphodiesterase type 5, increases cGMP in the corpus cavernosum
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what is the drug interaction with sildenafil?
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nitrites for chest pain (like the commercial says!)
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What happens in acute nitrate toxicity?
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pronounced vasodilation, leads to orthostatic hypotension, tachycardia, throbbing headaches
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what happens upon repeat expose to nitrates?
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tolerance will develop- reducing the magnitude and effects of nitrates
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What line of work has high exposure to nitrates? what 'disease' does this cause?
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people who make explosives
this causes tolerance to nitrates, but you have "monday disease", where tolerance goes down over the weekend...and you get headache and dizzyness on monday due to high nitrate levels again |
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What are the two important intracellular calcium functions?
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triggers muscle contraction in heart/smooth muscle
required for pacemaker activity in the SA node and conduction through AV node |
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What opens calcium channels in the heart and smooth muscle?
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beta adrenergic stimulation
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what closes calcium channels in the heart and smooth muscle?
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calcium channels antagonists
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What type of receptors do Calcium channel antagonists bind to?
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L-type channels
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how do Calcium channel antagonists affect smooth muscles?
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these relax all smooth muscles, especially vascular smooth muscle
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What are the major cardiac effects of Calcium channel antagonists?
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negative inotropic
reduced impulse generation in SA node slowed AV conduction |
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What type of drug is nifedipine? what is it best at?
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this is a Calcium channel antagonist, and it is the strongest vasodilatior
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what type of is verapamil? what is it best at?
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this is a Calcium channel antagonist, and it is the strongest cardiac effects
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What Calcium channel antagonist is most likely to produce reflex tachycarida?
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Nifedipine, because it is the strongest vasodilator
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What Calcium channel antagonist is most likely to depress SA node and AV node?
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Verapamil
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What are the harmful effects of Verapamil and Diltiazem?
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these can cause serious cardiac depression
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How are Calcium channel antagonists given?
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Oral administration
Considerable first pass metabolism |
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How are Calcium channel antagonists metabolized?
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by the liver
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What is the half life of Calcium channel antagonists?
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3-5 hours, but there are slow release formulations available
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How do Beta blockers affect lipids?
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this causes an increase in plasma lipids
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How do beta blockers affect diabetics?
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type 2 diabetics will have Delayed recovery from insulin induced hypoglycemia
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How does Ranolazine work? (3 things)
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this is a partial fatty acid oxidation inhibitor.
inhibits late inward Na+ current decrease LV stiffness |
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What is Ranolazine used for?
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this is used to treat chronic stable angina in pts who failed to respond to other anti-anginal medications
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What will effective angina pectoris therapy achieve?
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increased exercise tolerance
decreased frequency and duration of ischemia |
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What is the major metabolizer of Sildenafil?
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hepatic CYP3A4
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How does sildenafil affect vision?
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it can inhibit PDE6 which does retinal cGMP metabolism
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What happens with sildenafil coadminstration with alpha blockers?
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hypotension
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How is Vardenafil (Levitra) different then Sildenafil (Viagra)
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Vardenafil is more selective for PDE5, so it has fewer visual disturbances
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How is Tadalafil (Cialis) different than Sildenafil (viagra)
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this has a longer duration of action (24-36) hours. Allows for more spontaneity in relationships.
no visual disturbances |
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What do endothelins do?
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these cause contraction of vascular smooth muscle
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What is Bosentan?
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this is a endothelin receptor antagonist
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What is Bosentan used for?
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this treats severe pulmonary hypertension
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How is Bosentan given?
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orally
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What are the side effects of Bosentan?
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elevated hepatic enzymes
teratogenic effects many drug interactions |
