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53 Cards in this Set
- Front
- Back
When O2 supply can't meet O2 demand, what happens?
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Ischemia
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In a pt. with renal heart disease, what is the result of coronary thrombosis/plaque disruption?
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Unstable Angina
MI |
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In a pt. with renal heart disease, what is the result of Transient Coronary Ischemia?
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Angina Pectoris
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This condition is caused by a decrease in coronary blood flow due to vasospasm
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Variant or Prinzmetal's Angina
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When does Prinzmetal's angina often occur?
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at rest or during sleep
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What do you think will help allevite pain from an attack of Variant/Prinzmetal's angina?
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Increase O2 supply..
Give a vasodilator like a nitrate. Dilating the coronaries stops vasospasm and alleviates the ischemic pain |
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Stable angina is caused by what disease?
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Atherosclerosis
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Explain Stable Angina and exertion.
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Patient has atherosclerosis.
Upon exertion there is an increase in O2 demand BUT NO INCREASE in blood flow |
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Why is there no increase in O2 supply with exercise in a person with stable angina?
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B/C the coronary arteries are clogged up..
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Will arteries with atherosclerotic plaque vasodilate?
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No
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Ischemia results from:
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an increase in O2 demand in the face of a fixed O2 supply
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What will alleviate the pain from an attack of stable angina?
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Decrease O2 demand
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How can you reduce O2 demand?
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↓HR
↓myocardial contractility DILATE peripheral arteries & veins |
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What are the tx goals in a patient with Chronic Stable Angina?
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Prevent MI and Death
↓symptoms of angina and occurrence of ischemia |
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Which type of β Blockers are most effective at treating stable angina?
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All β blockers are equally effective in treating stable angina
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MOA: β blockers in Stable Angina
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Block β1 receptors on heart
↓HR and Contractility ↓O2 demand Also, ↓BP --> ↓O2 demand |
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What other organs besides the heart are involved with ↓BP with β blockers?
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Kidneys, Brain (CNS)
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What is the recommended first line therapy for stable angina?
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β blockers
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What are contraindications for use of β blockers for tx of stable angina
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Heart Block
Heart Failure Asthma |
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"Nite"
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Organic Nitrates and Nitrites
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MOA: low dose Organic Nitrates and Nitrites
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Release of NO
↓ Dilate Veins ↓ ↑Venous capacitance ↓ ↓Preload ↓ ↓Ventricular EDV ↓ ↓Wall tension ↓ ↓O2 Demand |
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MOA: high dose Nitrate
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Dilate arteries
↓ ↓PVR ↓ ↓ afterload ↓ ↓O2 demand |
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Which type of vasculature dilates the easiest?
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Veins
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Dilating veins would be beneficial in what type of angina?
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Stable Angina
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Can nitroglycerine effectively dilate an atherosclerotic epicardial coronary artery?
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No
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**EXAM**
When nitroglycerine is injected directly in the CA of patients with CAD, anginal attacks do not go away Sublingual nitro relieves pain in these same patients. What does this tell us? |
Nitroglycerine is reducing angina by VASODILATING VEINS
**EXAM*** |
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The antianginal effect of nitroglycerine can be mimicked with _______
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phlebotomy
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**EXAM**
How does nitroglycerine relieve the pain of stable angina? |
Mainly by ↓ O2 demand by VASODILATING VEINS
**EXAM** |
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What is the MOA for nitrates in VASOSPASTIC Angina?
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Release of NO
↓ Dilation of Coronary aa. ↓ Relieve Vasospasm ↓ ↑O2 Supply |
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Why is hydralazine (arterial VD) not used for stable angina?
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It aggravates angina and ischemia
**Too much reflex tachycardia** **Dilation of coronary resistance arterioles** --> Steals blood from ischemic areas |
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How would you administer Nitroglycerine for Unstable Angina or an Acute MI?
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IV
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Why use Nitrates in combination with β blockers?
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β blockers will suppress reflex tachycardia caused by Nitrates.
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If β blockers can't be tolerated for tx of Stable Angina, what is your next best choice?
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Nitrates and Nitrites
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How do you prevent tolerance with chronic use of nitrates?
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a nitrate-free interval each day
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What mechanism of nitrates causes acute reactions such as:
Headache Flushing Ortho Hypotension Dizziness Reflex Tachycardia |
Vasodilation
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What types of drugs do nitrates have an adverse interaction with?
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Erectile Dysfunction Drugs
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When nitrates are taken with erectile dysfunction drugs, what protein concentration is increased leading to severe hypotension and possible MI?
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cGMP concentration is increased because erectile dysfunction drugs block PDE-5 which metabolizes cGMP
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What metabolizes cGMP?
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PDE-5
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do DHP CCBs reduce afterload of preload?
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Reduce afterload
Dilating arteries reduces afterload |
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what will happen to HR with Nifedipine?
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HR INCREASES d/t reflex tachycardia
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MOA: DHP CCBs in stable angina?
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VD arteries
↓ ↓Afterload ↓ ↓Wall Stress ↓ ↓O2 Demand |
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What is the difference between Nifedipine and Non-DHP CCBs?
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Non-DHP CCBs directly affect the heart AND peripheral vasculature
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MOA: Non-DHP CCBs in stable angina?
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↓Afterload
↓ ↓Wall Stress ↓ ↓O2 Demand ****AND**** ↓HR & Contractility ↓ ↓O2 Demand |
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MOA: CCBs in Vasospastic Angina?
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CCBs
↓ Dilate epicardial coronary aa. ↓ ↓Vasospasm |
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MOA: Ranolazine
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Blocks late cardiac Na current
(late I NA channels) |
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Late INA occurs during which phase of the action
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Phase 2
Late INA channels cause depol |
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How is Late INA related to ischemia?
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During ischemia there is a peak in Late INA --> Ca++ Overload
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What does Ca++ Overload do in ischemic myocardium?
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Increases diastolic wall tension which causes an INCREASED O2 demand
The diastolic wall tension also compresses coronary arteries which REDUCES O2 SUPPLY |
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What is the overall use for Ranolazine?
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It reduces anginal attacks
It increases excercise intervals |
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This drug causes dizziness, headache, constipation and a prolonged QT interval...
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Ranolazine
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How does Ranolazine prolong QT? What is the problem with this?
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It blocks K+ channels
Potential for cardiac arrythmia |
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Would you prescribe Ranolazine to someone with hepatic dysfunction?
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NO
Ranolazine is metabolized by CYP450 3A in the liver |
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Should you use CYP450 3A inhibitors along with Ranolazine
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NO
Ranolazine is metabolized by CYP450 3A |