Term
| Problem in ischemic heart disease |
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Definition
| Oxygen demand exceeds the oxygen supply |
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Term
|
Definition
Angina- transient MI
Acute MI- prolonged deprivation of O2 to some of myocardium> irreversible necrosis
Sudden Death> ischemia triggering V-FIB. CO Stops! |
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Term
|
Definition
Decrease blood flow
Increased Oxygen Demand (exercise, sympathetics, hyperthyroid)
Decreased Oxygenation (anemia) |
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Term
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Definition
Chest pain described as smothering, choking, heavy, pressure, squeezing.
May radiate to Jaw, neck, shoulders, arms. |
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Term
| What is the pain in Angina pectoris a result of? |
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Definition
| From stimulating nerve fibers by toxins released from damaged tissue or by stretching the coronary vessels as they dilate to increase coronary blood flow. |
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Term
| What is unstable angina generally associated with? |
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Definition
Rupture of an athersclerotic plaque.
Occur at rest
Do not respond to rest or nitroglycerin |
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Term
|
Definition
| Either increase metabolism of or release of NO. This leads to eventual vasodilation |
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Term
|
Definition
| NO> (+) guanylyl cyclase> Increased cGMP> (+) PKG> 4 actions (on a later notecard) |
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Term
| 4 Actions Resulting from Activation PKG |
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Definition
1. (+) of MLC Phosphatase> inhibits contraction
2. Block Ca channel on membrane, decreasing Ca entry
3. Activating pumps pumping Ca Out of cell
4. Decreasing Ca release from SR |
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Term
| Possible Effect of Nitrates on K |
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Definition
| May activate K channels causing efflux and hyperpolarization. This leads to relaxation of vessels. |
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Term
| What does low dose nitrate do? |
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Definition
| Low: dilate venous capacitance, increasing venous return and preload, decreasing CO demand. (Check this cuz Katy and I's notes were different) |
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Term
| What does high dose nitrate do? |
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Definition
| Relax arteriolar resistance, decreasing afterload and O2 demand |
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Term
|
Definition
| Raynaud's Phenomenon- vasospastic disorder causing decreased blood flow to extremities |
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Term
| 3 Problems with Nitrate Rxs |
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Definition
1. Tolerance
2. Excess vasodilation with baroreflex causing increased HR and afterload
3. Steal phenomenon |
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Term
| What Syndrome can nitrates exacerbate? What is the hallmark of this? |
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Definition
Shy-Drager Syndrome
Hallmark: Postural hypotension with total failure of compensatory tachycardia |
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Term
| How is nitroglycerin metaboloized? |
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Definition
mitochondrial aldehyde dehydrogenase
* 30-50% Asians have inactive form of mALD! shit i better not get IHD! |
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Term
| Which forms of nitroglycerine are more likely to develop tolderance |
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Definition
| oral and transdermal (not sublingual) |
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Term
| When to give IV NTG and what is unique about this process? |
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Definition
| Give in emergency setting, need special tubing so drug doesn't adsorb to tubing. |
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Term
When to use sublingual NTG?
Oral? Transdermal? |
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Definition
Sublingual: acute attacks
Orals and transdermal: prophylaxis |
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Term
| 2 Nitrate Drugs, Oral only |
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Definition
Isosorbide Dinitrate
Isosorbide Mononitrate |
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Term
|
Definition
| Vasodilation, postural hypotension, HA, tachy/palpitations |
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Term
| Rare SE of Organic Nitrates involving Hg |
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Definition
Methemoglobinemia from nitrate--> nitrite oxidation.
Nitrite oxidize Fe++ to Fe+++, which decreases O2 carrying capacity |
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Term
| How do you treat methemaglobinemia? |
|
Definition
(He said to look it up, this is from Wiki)
Supplemental Oxygen
Methylene Blue: Reduces iron to normal oxygen carrying state |
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Term
| What drug not to use with Nitrates, why? |
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Definition
Viagra
Inhibits PDE5 which also increases cGMP. This exacerbates nitrates' moa and leads to massive reflex tachy and sudden DEATH!!!! |
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Term
| Other Severe SE of Sildenafil (Viagra) |
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Definition
Impaire blue/green color discrimination via PDE6 inhibition--> permanent blindness esp in those with DM, HTN, other diseases
NO released can also be antiplatelet acting |
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Term
| What types of Angina do you treat with BBs? |
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Definition
| Exertional (Stable, classic) |
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Term
|
Definition
(-) Inotropic and chronotropic
Decreased renin from juxtaglomerular cells |
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Term
What of BB mechanism decreases preload?
afterload? |
|
Definition
Preload: inhibiting aldosterone
Afterload: inhibiting renin |
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Term
| Problem with Beta Blockers |
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Definition
Increased LVEDV
Increased Coronary Vascular Resistance |
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Term
| Advantages of BB+Nitrate Combo |
|
Definition
BB: block reflex tachy and (+) inotropic from nitrate
NITRATES: Increased venous capacitance, offsetting the LVEDV from BB |
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Term
| Name the Beta 1 Selective blocker Thingys |
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Definition
|
|
Term
| Which BBs are nonselective? |
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Definition
|
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Term
| What conditions do you want to use caution when using BBs? |
|
Definition
Asthma
Diabetes
Hyperlimidemia |
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Term
| Which class of Ca Channel Blockers does the reflex sympathetics overshadow its (-) inotropic effect? |
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Definition
|
|
Term
| Name the 3 Classes of Ca Channel Blockers |
|
Definition
Phenylalkylamines (verapamil)
Benzothiazepines (diltiazem)
Dhydropyridines (Nifedipine) |
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Term
| Net effect of Ca Channel Blockers |
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Definition
| Decrease Ca influx into arteriolar vascular smooth muscle and cardiac muscle |
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Term
| Do CCBs decrease preload or afterload? |
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Definition
|
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Term
|
Definition
Angina (sometimes with nitrates to get additive preload decrease)
HTN
Arrhythmias |
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Term
| Which CCB causes most constipation and why? |
|
Definition
| Verpamil because of its affinity to intestinal smooth muscle Ca channels |
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Term
| Uses of Diltiazem and Verapamil |
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Definition
| SVT, angina, A-Fib/flutter |
|
|
Term
| CCBs acting mainly on vascular smooth muscle (7) |
|
Definition
Nifedipine
Nimodipine
Nisoldipine
Isradipine
Felodipine
Amlodipine |
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Term
| When using CCBs, especially those working on vascular SM, what formulation should you avoid? Why? |
|
Definition
| Short acting. Causes reflex increase in sympathetic activity and activations RAAS |
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Term
|
Definition
Cirrhosis- metabolized by liver
CHF: because they are (-) inotropes
Grapefruit Juice: inhibit metabolism |
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Term
|
Definition
| Raynaud's phenomenon (dihydropyridine use) |
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Term
| SE of CCBs? Which class mostly has these SE? |
|
Definition
HA, Facial flushing, Dizzy, PEDAL EDEMA
Dihydropyridines |
|
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Term
| SX of decompensation in CHF from CCB use |
|
Definition
| Fatigue, SOB, edema, paroxysmal nocturnal dyspnea |
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Term
| Drug used for chronic angina in non responsive patients |
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Definition
|
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Term
| What Drug Prolongs Q-T interval |
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Definition
|
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Term
|
Definition
Inhibits late Na current, leading to less Na/Ca++ exchange, causing less inotropy
Inhibits FA oxidation, shifitn gmetab to glucoseDrug m |
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Term
|
Definition
| CYP3A4, CYP2D6. Careful if liver imparied |
|
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Term
| Most common SE of RanolazineDizzy HA Nausea, constipation |
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Definition
|
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Term
| Myocardial Infarction Treatment Drugs (7) |
|
Definition
Oxygen
Analgesia
IV Nitroglycerin
Beta Blockers
Lidocaine
Aspirin
Thrombolytics |
|
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Term
|
Definition
Analgesia
Reduced anxiety
blocked sympathetic outflow from CNS
Releases histamine |
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Term
| Caution when using morphine in MI patient |
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Definition
| Venous pooling might decrease preload causing less BP and CO |
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Term
|
Definition
| Decreased incidence of ventricular arrhythmias, re-infarction and mortality if given within 12 hours of chest pain onset. |
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Term
| Lidocaine Use in MI Patient |
|
Definition
| Blocks Na channels, inhibiting depolarization. used for ventricular arrhythmias from high catecholamine levels released in response to ischemia |
|
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Term
| MOA of Aspirin in MI Patient |
|
Definition
| Antiplatelet to prevent clots |
|
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Term
| Thrombolytics MOA in MI Patient |
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Definition
| tPA help form plasmin from plasminogen which then metabolizes fibrin causing dissolution of the clot. |
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Term
| What are the Tissue Plasminogen Actiators |
|
Definition
Alteplase Recombinant
Reteplase Recombinant
Tenecteplase |
|
|
Term
| All the tPAs are for acute MI, one has 2 additional other uses. Which drug is this and what are the 2 other uses? |
|
Definition
Alteplase Recombinant
Acute Ischemic Stroke and pulmonary embolism |
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|
Term
| Where is streptokinase from? |
|
Definition
| Derived from Beta hemolytic streptococcus |
|
|
Term
|
Definition
| Complezes with plasminogen causing cleavage of plasminogen to plasmin, which dissolves clots |
|
|
Term
| When should you not use thrombolytics |
|
Definition
| IF PATIENT HAS ULCERS OR ANY OTHER SX OF BLEEDING! |
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