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42 Cards in this Set
- Front
- Back
Which portions of the heart are supplied by the Circumflex artery?
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1. Left atrium
2. Side/back of left ventricle |
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Which portions of the heart are supplied by the Left anterior descending artery?
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1. Front/bottom of left ventricle
2. Front of the septum |
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Which portions of the heart are supplied by the Right coronary artery?
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1. Right ventricle
2. Bottom portion of left ventricle 3. Back of the septum |
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List 4 factors that influence coronary blood flow.
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1. Heart rate
2. Contractility 3. Preload 4. Afterload |
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Define angina pectoris.
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Discomfort or pain associated with an imbalance between myocardial oxygen supply and demand
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How is the experience of angina in women different than that experienced by men?
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Women usually have an "atypical" presentation of anginal pain:
1. May have no sensations from chest, instead --> jaw, neck, shoulders, back 2. Chest sensation may full, sharp, stabbing, or burning pain 3. Pain is longer, more severe, more frequent |
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What is the usual cause of stable angina?
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Atheromatous lesion
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What is the usual cause of unstable angina?
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Rupture of atherosclerotic clot
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What is the effect of nitrates at low therapeutic doses?
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Venous smooth muscle relaxation
(increases venous capacitance) 1. Lower venous return --> lower preload 2. Lower wall tension --> lower O2 demand 3. Lower stroke volume --> lower cardiac output |
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What is the effect of nitrates at high therapeutic doses?
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Arterial smooth muscle also relaxes
(reducing total peripheral resistance) |
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Do nitrates directly influence coronary blood flow by dilating the vasculature?
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No.
(flow is not changed) |
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What are nitrates typically used to treat?
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1. Stable angina
2. Variant angina 3. Unstable angina |
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Nitrates are contraindicated in which patients?
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Those taking PDE5 inhibitors
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Which specific channel do the Ca2+ channel blockers work on?
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Voltage-gated L-type slow Ca2+ channels
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What type of drug is Bepridil?
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Ca2+ channel blocker
(similar to Verapamil) |
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Which drug is similar to Verapamil, but more effective at blocking Na+ channels?
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Bepridil
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What is an adverse side effect of Bepridil?
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Increases AV nodal refractory period, which may lead to torsades de pointes
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Bepridil is prescribed to patients in what circumstance?
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When the patients don't respond to other drugs
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What is the effect of all calcium channel blockers?
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Reduce myocardial O2 demand
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Which types of angina are Ca2+ channel blockers effective for?
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1. Stable angina
2. Variant angina (Not very good for unstable angina, unless stability is due to vasospasm) |
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List 2 adverse effects of Ca2+ channel blockers?
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1. Hypotension
2. Headache |
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What is the main adverse effect of nitrates?
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Hypotension/ orthostatic hypotension
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What is the MOA of beta blockers?
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Block B1 adrenergic receptors
1. Decrease heart rate 2. Decrease contractility 3. Decrease AV conduction speed |
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How do beta blockers increase myocardial blood supply?
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They cause longer periods of diastole, allowing more blood flow
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Beta blockers are effective treatments for which heart conditions?
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1. Stable angina
2. Unstable angina 3. Silent ischemia (Not good for variant agina) |
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What is the major adverse effect of beta blockers?
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Congestive heart failure
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For which conditions are beta blockers contraindicted?
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1. Asthma
2. Bronchospasm |
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List 3 drug combinations for treating agina.
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1. Nitrates + B-blockers
2. Nitrates + B-blockers + Ca2+-channel blockers (dihydropyridines) 3. Nitrates + Ca2+-channel blockers |
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What is the MOA of erectile dysfunction drugs?
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Inhibit PDE5, prolonging the action of cGMP.
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List two ED drugs.
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1. Sildenafil (Viagra)
2. Alprostadil (Caverject) |
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ED drugs are contraindicated when a patient is taking which other medications?
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1. Nitrates
2. alpha-adrenergic antagonists |
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How is Alprostadil administered?
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1. Injected into cavernosal tissue
2. Placed into urethra as a minisuppository *Phentolamine can also be injected into cavernosa to produce erections |
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NO causes guanylyl cyclase to convert GTP to cGMP, which then activates PKG. List 5 structures that PKG phosphorylates to cause vasodilation
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1. L-type Ca2+ channel
2. Ca2+-ATPase 3. Ca2+ dependent K+-channel 4. Phospholamban 5. Phosphatase |
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List the steps to the molecular pathway that are blocked by Beta-blockers.
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B1-receptor inhibition, blocks the following events:
1. Adenyl cyclase conversion of ATP --> cAMP 2. cAMP activation of PKA 3. PKA phosphorylation of L-type Ca2+ channel and Ryanodine receptor 4. Ca2+ influx into cytoplasm from extracellular space and from SR |
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What is the function of PDE5?
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PDE5 converts cGMP --> 5'-GMP
(disabling the action of cGMP, decreasing vasodilation) |
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Atheromatous plaques most commonly occur within which portions of the coronary arteries?
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Within the first few centimeters of any of the coronary arteries
(most proximal portions) |
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When does most of the blood flow in the left coronary artery occur (systole/diastole)?
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Diastole
(compression of left ventricle during systole produces a force greater than the arterial pressure in the L coronary artery) |
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When does most of the blood flow in the right coronary artery occur (systole/diastole)?
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Systole
(pressure in the aorta is greater than right ventricle) |
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Coronary blood flow is proportional to....?
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Myocardial oxygen demand
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What are the 4 factors that determine myocardial oxygen demand?
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1. *Preload (diastolic wall tension)
2. *Afterload (systolic wall tension) 3. Heart rate 4. Contractility |
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How do nitrates relax smooth muscle cells?
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Smooth muscle cells enzymatically convert nitrates to nitric oxide, which relaxes the cells through the guanylyl cyclase system
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What is the primary hemodynamic effect of nitrates that relieves angina?
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Increase in venous compliance with resultant decrease in myocardial oxygen demand
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