Cv: Test 2: 9. Maloney: Peripheral Vascular Disease Drugs

Front 1

what are 2 major problems/risks seen with peripheral arterial disease

Back 1

Causes intermittent claudication

Markedly increased risk of cardiovascular morbidity and mortality

Front 2

if you have a plaque build up, what does this do to NO levels after the plaque?

Back 2

they go down, because not as much blood can get by

Front 3

what are the 2 end results of peripheral arterial disease?

Back 3

Reduced blood flow and oxygen delivery to tissues
This causes pain with walking (increased oxygen demand of skeletal muscle)

Front 4

what would happen if you gave an alpha blocker (nonspecific) to a person with peripheral arterial disease, would it get better or not?

Back 4

NO

you dilate all the arteries, not selectively dilate the ones downstream of where the plaque is located

Front 5

What are 2 drugs used to treat claudication symptoms?

Back 5

Cilostazol

Pentoxifylline

Front 6

What is the mechanism of action for cilostazol?

*****

Back 6

inhibits phosphodiesterase type III

increase cAMP in platelets

decreases platelet aggregation

thus decreasing intermittent claudication

(note, this also increases cAMP in vasculature, leading to more vasodilation in mainly femoral arteries, leading to a decrease in intermittent claudication)`

Front 7

why is cilostazol contraindicated in HF?

Back 7

Milrinone is a PDE inhibitor and decreases survival with chronic use in heart failure....so we pretty much just assume that because a different PDE inhibitor (which is how cliostazol works(PDE III)) we think cliostazol will probably be bad too

Front 8

What is the mechanism of Pentoxifylline ?

*****

Back 8

Increases erythrocyte flexibility --> increase blood flow-->increase tissue oxygenation

decreases plasma fibrinogen-->decreases blood viscosity--->increase blood flow-->increase tissue oxygenation

Front 9

Which drug works better cilostazol or pentoxifylline?

Back 9

cilostazol

THUS IT IS FIRSTLINE FOR PAD

Front 10

13

Back 10

Prohibition of slavery

Hint 10

Amendment 13 - Slavery Abolished. Ratified 12/6/1865. History

1. Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.

2. Congress shall have power to enforce this article by appropriate legislation.

Front 11

What is Raynaud's disease? General treatment?

Back 11

Vasospasm of small arteries in the skin of the hands and feet with intermittent pallor or cyanosis

General Treatment: Vasodilators

Front 12

What kind of vasodilators might be used to treat Raynaud’s Disease?

*****

Back 12

CCBs, alpha antagonists, Direct vasodilators, nitrates, ACE inhibitors

(Examples: Amlodipine, Lisinopril, Nitroglycerin, Prazosin)

Front 13

Pt is diagnosed with Stage 1 HTN and Raynauds, what would be the most useful in treating this pt?

Back 13

CCB (amlodipine)

Front 14

Elevated pulmonary vascular resistance leads to ______ which ultimately leads to _____

Back 14

pulmonary hypertension

right sided HF

Front 15

What is the mechanism by which pulmonary vascular resistance is elevated??

Back 15

increased endothelin

decreases prostacyclin and NO

leads to smooth muscle dysfunction (abnormal Ca handling) in pulmonary arteries

Front 16

What does endothelin do? (2)

Back 16

Vasoconstrict

increase smooth muscle proliferation

Front 17

What does prostacyclin and NO do?
(3)

Back 17

Vasodilate

Decreases cell proliferation

Inhibits platelet aggregation

(note this is the opposite of endothelin)

Front 18

what population is affected by pulmonary arterial hypertension?

Back 18

young women

Front 19

What kind of vasodilators may be useful in pulmonary arterial hypertension?

Back 19

most vasodilators are not effective in chronically reducing pulmonary vascular resistance and increasing CO....

so they aren't gonna help much (this is because there are different receptors on pulmonary vasculature than in systemic...not many a1 receptors)

Front 20

What are 4 basic ways to stop PAH?

Back 20

Front 21

do you use verapimil in people with PAH? why?

Back 21

no, too big of a negative ionotropic effect

Front 22

CCBs are used for PAH... do they work really well for people?

Back 22

they only work for about 10-15% of pts but for those that it does work for, it gives long term survival

Front 23

How do you determine if a person will respond to a CCB?

Back 23

acute vasoreactivity test

administer a very short acting vasodilator (either IV epoprostenol (prostacyclin), IV adenosine, or inhaled NO)

Front 24

outline the acute vasoreactivity test

Back 24

Front 25

if the drug has the word 'prost' in it what kind of drug is it

Back 25

prostacyclin analog

Front 26

what kind of drug is Epoprostenol

Back 26

prostacyclin analog

Front 27

what kind of drug is Treprostinil

Back 27

prostacyclin analog

Front 28

what kind of drug is Iloprost

Back 28

prostacyclin analog

Front 29

what is the mechanism of action for the prostacyclin analogs?

Back 29

Dilates pulmonary vessels
Decrease pulmonary vascular resistance
Probably a small degree of systemic vasodilation
Inhibits platelet aggregation
Antiproliferative effects

Front 30

between Epoprostenol, teprostinil, and Iloprost...... order the half life

Back 30

Epoprostenol: 6 minutes (central venous catheter)

Treprostinil: 4 hours (central venous catheter or inhalation)

Iloprost: 20-30 minutes (inhalation)

Front 31

what is the major problem with SubQ treprostinil?

Back 31

super painful at injection site...like to the point of not being able to bear it

Front 32

what is the problem with iloprost and pt use?

Back 32

have to inhale it for 10-12 minutes for 6-9x a day

Front 33

if a drug has 'sentan' in it what does it do?

Back 33

Endothelin Receptor Antagonists

Front 34

what kind of drug is Bosentan

Back 34

Endothelin Receptor Antagonists

Front 35

what kind of drug is Ambrisentan

Back 35

Endothelin Receptor Antagonists

Front 36

Which receptors would you rather block, Endothelin A or B? Why?

Back 36

Endothelin A

that will remove the constriction proliferation

Front 37

What specific receptor(s) does bosentan block?

Back 37

ETa and ETb

remember this is an Endothelin Receptor Antagonists

Front 38

What specific receptor(s) does Ambrisentan block?

Back 38

ETa

remember this is an Endothelin Receptor Antagonists

Front 39

What is an important consideration for a young woman who is on bosentan

Back 39

it decreases the concentration of contraceptives...aka you need to have 2 forms in order to be babyproof

Front 40

how do sildenafil and tadalafil work?

Back 40

decrease platelet activation and smooth muscle aggregation via preventing the breakdown of cGMP

Front 41

what breaks down cGMP?

Back 41

PDE-5

Front 42

what is a problem with people using nitrates for pulmonary arterial hypertension?

Back 42

it will drop BP too much

Front 43

what is the first thing you will do when someone is diagnosed with PAH

Back 43

do a vasoractivity test and see if they can use a CCB

Front 44

what is the only drug that can reduce mortality with PAH and is first line with people that are the worst patients (class IV)

Back 44

epoprostenol