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Antianginals
N/A
50
Pharmacology
Professional
04/03/2011

Additional Pharmacology Flashcards

 


 

Cards

Term
acute coronary syndrome (ACS)
Definition
unstable angina-->non-transmural MI-->transmural (acute) MI
Term
Unstable angina is characterized by...
Definition
ST depression
no enzyme release
Term
non-transmural MI is characterized by...
Definition
ST depression, T wave inversion or normal
no Q waves
release of enzymes (CPK, LDH, +/- troponin)
Term
transmural (acute) MI is characterized by...
Definition
ST elevation
Q waves present
release of enzymes (CPK, LDH, troponin)
Term
2 major activities of myocardial cells
Definition
contraction
relaxation

both require oxygen!
Term
Increases in O2 demand can only be met by...
Definition
increased coronary blood flow
Term
The coronary blood flow occurs during ________. The _______ of this important for determining blood flow.
Definition
diastole; duration
Term
Angina and possibly cardiac damage occurs when...
Definition
the O2 supply cannot keep up with the energy requirements of the heart.
Term
Myocardial ischemia occurs when...
Definition
myocardial oxygen demand exceeds myocardial oxygen supply
Term
nitrovasodilator mechanism of action
Definition
relax almost all smooth muscle by releasing NO which then stimulates the release of cGMP
Term
primary response to nitrovasodilator
Definition
peripheral venodilation (especially in large veins)
Term
secondary response to nitrovasodilator
Definition
arteriolar dilation
Term
third response to nitrovasodilator
Definition
increased oxygen supply to ischemic areas of myocardium
Term
How does peripheral venodilation of large veins aid in anginal attacks?
Definition
reduces venous return which reduces CO preload and thus myocardial workload
Term
How does arteriolar dilation aid in anginal attacks?
Definition
reduces cardiac afterload and thus myocardial workload and oxygen demand
Term
NTG therapeutic uses
Definition
acute angina attack
Prinzmetals angina (relief of coronary artery vasospasm)
Term
Direct infusion of NTG into the heart does/does not relieve angina.
Definition
does not
Term
dose for short-acting NTG
Definition
0.4 mg given SL
Term
amyl nitrate
Definition
inhalant NTG
Term
NTG directions to pt
Definition
1. 1st tab SL, wait 5 min
2. If pain remains, take 2nd tab, wait 5 min.
3. If pain remains, take 3rd tab, wait 5 min.
4. If pain remains, go to ER!
Term
long-acting nitrovasodilators
Definition
isosorbide dinitrate
isosorbide mononitrate
Term
To minimize development of tolerance, ensure daily NTG-free interval of __________ is provided.
Definition
10-12 hrs
Term
During administration of SL tabs or TL spray, pt should...
Definition
rest, preferably in the sitting position
Term
NTG undergoes extensive...
Definition
first pass hepatic metabolism
Term
NTGs may elicit...
Definition
attack of angina via "stealing effect"
Term
NTGs adverse reactions
Definition
headache, postural hypotension, reflex tachycardia and/or contractility
Term
NTG contraindication
Definition
PDE-5 inhibitors
Term
mechanism of PDE-5 inhibitor and NTG drug interaction
Definition
PDE-5 inhibitors lead to reduced breakdown of cGMP

nitrates enhance production of cGMP

dramatically enhanced vascular effects, including severe hypotension
Term
beta blocker mechanism of action in angina
Definition
reduce heart rate and increase duration of diastole, which allows more coronary perfusion
Term
By blocking the effects of _______________ on the heart, beta blockers reduce contractility.
Definition
catecholamines
Term
Reduction in contractility reduces LV wall tension, resulting in...
Definition
lower myocardial O2 demand
Term
Beta blockers decrease the ____________ and raise the ___________.
Definition
frequency of anginal episodes; anginal threshold
Term
What do beta blockers do for post-MI pts?
Definition
reduce mortality and re-infarction
Term
Abrupt withdrawal of beta blockers can precipitate...
Definition
unstable angina and MI in pts with chronic CAD
Term
beta blocker therapeutic uses
Definition
angina pectoris
post MI
Term
cardioselective beta blockers
Definition
atenolol
metoprolol
nevibolol
Term
non-cardioselective beta blockers
Definition
nadolol
propranolol
Term
beta blocker contraindications
Definition
Prinzmetals angina
asthma
acute CHF
Term
primary cardiac calcium channel blockers
Definition
verapamil
diltiazem
Term
For BP control, rate the effectiveness of calcium channel blockers.
Definition
DHPs (nifedepine) much better than diltiazem=verapamil
Term
For myocardial tissue, rate the effectiveness of calcium channel blockers.
Definition
verapamil may be slightly better than diltiazem, but both are much better than DHPs (nifedipine)
Term
CCB adverse effects
Definition
peripheral edema, headache, flushing, palpitations, gingival hyperplasia, constipation
Term
Prinzmetals angina
Definition
-occurs in pts with non-narrowed coronary vessels
-have atherosclerosis but nothing that causes much constriction
-usually constrict and spasm in the AM causing reduced blood flow
Term
possibilities in treating Prinzmetals angina
Definition
-nitrates (reduce spasm)
-CCBs (relax smooth muscle-->reduce spasm)
-beta blockers (will NOT reduce spasm)
Term
official treatment of Prinzmetals angina
Definition
1. CCB (DHPs such as nifedipine and amlodipine reduce frequency)
2. nitrates (good for acute symptoms or long-acting nitrates if CCBs don't work)
Term
Why is clopidogrel (Plavix) preferred over aspirin in treatment of angina?
Definition
no effect on prostaglandings
-if loop diuretic is being used
-if kidney disease is present
Term
What drug is approved for treatment of unstable angina when angioplasty or atherectomy is planned within 24 hours?
Definition
abciximab
Term
____ and ______ are beneficial for ACS.
Definition
ASA and heparin
Term
ER protocol for chest pain
Definition
IV line
O2
ASA
NTG
morphine
Term
ACS treatment guidelines (chronic meds)
Definition
ASA
clopidogrel
ACE inhibitor
betea blocker
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