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49 Cards in this Set
- Front
- Back
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characterization of atherosclerotic angina
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where you have a greater demand of oxygen in myocardial tissue than current perfusion can deliver
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vasospastic angina
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where vasospasm reversibly compresses vessels causing a disruption in blood flow
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unstable angina
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characterized by an increase in atherosclerotic plaques, platelet aggregation and vasospasm, involves pain at rest, usually a medical emergency
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monday disease
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where exposure to nitro build resistance and repeated exposure after non exposure enduces headaches and dizzyness due to hypotension
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nitrate tolerance
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where effect of nitrate is lost after repeated dosings after 10-12 hours
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preload
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dealing with diastolic muscle fiber stretch and tension
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afterload
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resistance to ejection and stroke volume, afterload determines systolic fiber tension
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intramyocardial fiber tension
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force exerted by myocardial fibers at any given time, a precursor for O2 requirement
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double product
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product of heart rate and systolic blood pressure, measure of cardiac work
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myocardial revascularization
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mechanical intervention to improve O2 delivery by bypass or angioplasty
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myocardial fiber tension
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the higher the tension in the fibers, the higher the oxygen requirement
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faster heart rate contributes to fiber tension how
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when heart beats faster, fibers spend more time at systolic tension levels
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how does faster heart rate reduce perfusion
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perfusion is almost nil during systole, and the faster the heart rate the less time is spent in diastole
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cardiac contraction is controlled by what
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sympathetic outflow to the heart
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ejection time relation to force of contraction
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inverse relationship
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increased ejection time signifies what
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larger oxygen demand by myocytes
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two ways to correct anginal pain
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increase blood flow, lessen oxygen demand
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what is a newer way of increasing the efficiency of oxygen utilization
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shifting cardiac muscle energy substrate preference from fatty acids to glucose
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what is the name of medicines that change heart energy substrate preference
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pFOX inhibitors - ranolazine, trimetazidine
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ivabradine
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reduce heart rate with no other effects, inhibition of SA node current
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what drugs reduce the oxygen requirement in atherosclerotic angina
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b blockers, nitrates, calcium channel blockers
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what drugs reduce vaso spasm
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calcium channel blocks, nitrates
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sublingual nitro duration of action time
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10-20 minutes
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transdermal nitro duration of action time
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8-10 hours
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where is nitroglycerin denitrated
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liver
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why is nitro metabolized so quickly
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high first pass effect in liver, 90% metabolized
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why does oral nitro last longer
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allows for higher amount of glycerol dinitrate in the blood - this is the more effective metabolite
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method of action for nitrate
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release of nitrates causes nitric oxide formation, increases guanylyl cyclase, increases GMP, leads to smooth muscle relaxation
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what are the results of nitro dosing
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venodilation which lead to lessened cardiac size and output through lessened preload
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venodilation results in what
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decreased diastolic heart size and fiber tension
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arteriolar resistance results in
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decreased systemic resistance and blood pressure
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what provides the most theraputic benefit for atherosclerotic angina
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reduction of oxygen demands
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side effects of nitro
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reflex tachycardia (from baroreceptors) and increased force of cardiac muscle contractions (also from baroreceptors)
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nitro in unstable angina
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used to reduce clotting
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transdermal nitro acts for how long
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24 hours, but reduced effectiveness after 10-12
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what drug has a bad reaction with nitro
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slidenafil - increases cGMP in smooth muscle - for ED
combined with nitro can cause severe systemic orthostatic hypotension |
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what do nitrates cause at high concentrations
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methemoglobinemia
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three step procedure for treatment of cyanide with nitrates
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amyl nitrite, sodium nitrite, sodium thiocynate
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preferred method of cyanide treatment
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hydroxocobalamin, vitamin B12 derivative
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why do calcium channel blockers not affect nerve impulses
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only work on voltage gated L-type channels, nerves use N, P and R channels. Secretory uses L, but it is less sensitive
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what two drugs reduce rate and contracility of the heart
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diltiazem and verapamil
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what calcium channel blocker is a better vasodilator
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nifedipine - can also increase heart rate by baroreceptor reflex
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ca channel blockers used as prophylactic for what
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effort and vasospastic angina
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CA channel blocker toxicity
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constipation, pretibial edema, nausea, flushing dizziness, heart failure, AV blockade, and sinus node depression
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main function of B blocker
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reduce cardiac work and oxygen demand
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result of B blocker
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decreased heart rate, cardiac force and blood pressure
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detrimental effects of b blocker
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incrased heart size, longer ejection period
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main use of b blocker
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prophylactic treatment of angina, useless for vasospasm, good for exercise induced angina
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why is b blocker always prescribed with nitro
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b blocker counteracts bad side effects of nitro (tachycardia and increased cardiac force)
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