Term
| 3 branches of the coronary arteries and what do they do |
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Definition
| -right ascending, left ascending and circumflex. Supply blood to heart |
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Term
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Definition
| insufficient blood supply to tissue (cardiac myocytes). leads to chronic coronary artery disease (stable angina) and acute coronary syndromes |
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Term
| chronic coronary artery disease (stable angina) |
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Definition
| coronary artery has a plaque formation so the lumen is narrowed and can't supply blood as well w/normal BV. at rest it is fine but when working out you will feel pain/discomfort |
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Term
| types of acute coronary syndromes |
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Definition
| unstable angina, non-ST elevation myocardial infarction and ST elevated myocardial infarction |
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Term
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Definition
| fibrous cap of plaque formation in the blood vessle ruptures and platelets aggregate to form a thrombus and if it grows to constrict blood vessle you get the symptoms at rest or while exercising. unpredictable!! |
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Term
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Definition
| chronic coronary artery disease and acute coronary syndromes |
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Term
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Definition
| doesn't require plaque formation. some pts have intense vasospasm and compresses the coronary artery so get angina symptoms that can occur at any time. |
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Term
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Definition
| plaque bulids up w/in wall of vessle until it ruptures and platelets aggregate and occlude vessle= heart attack |
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Term
| Treatment goal of stable angina |
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Definition
| restore balance between myocardial oxegyn supply and demand |
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Term
| What causes oxygen demand |
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Definition
| HR, contractility, increased preload and inc. afterload |
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Term
| what drugs can decrease oxygen demand |
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Definition
| B blockers and Ca+ blockers (can dec HR and contractility). organic nitrates can dec preload and afterload adn ca channel blockers can vasodilate |
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Term
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Definition
| coronary blod flow, aregional myocardial blood flow |
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Term
| what drugs can inc O2 supply |
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Definition
| vasodilators (esp ca+ channel blockers can inc coronary blood flow). Statins and anti-thromotics can inc regional myocardial blood flow |
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Term
| mechanical interventions that can inc O2 supply |
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Definition
| stents, angioplasty, bypass surgery |
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Term
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Definition
| when oxygen demand is greater than the supply |
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Term
| Vasodilators/organic nitrites/nitrates |
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Definition
| amyl nitrite, isosorbide nitrate, nitroglycerin |
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Term
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Definition
| amlodipine, nifedipine, diltiazem, verapamil |
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Term
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Definition
| atenolol, metoprolol, nadolol and propranolol |
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Term
| fatty acid oxidation inhibitor |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Organic nitrite/nitrates MOA |
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Definition
| endogenous NO from epithelial cells relaxes SM by inc cGMP. Organic nitrates react w/tissue thiols to generate NO which activate GC and inc cGMP. DEC Ca+ influx and inc sequestering of Ca in SR--> RELAXATION |
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Term
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Definition
| B-blocker w/NO generating effects |
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Term
| effect of organic nitrites/nitrateson venous vessles |
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Definition
| dilation of venous capacitance vessles, reduced venous return, LOWER PRELOAD, dec vent tension and reduces myocardial O2 demand |
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Term
| effect of org nitrites/nitrates on atria |
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Definition
| reduced resistance to vent emptying (REDUCED AFTERLOAD)--> dec cardiac work and reduces O2 demand! |
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Term
| effect of decreasing afterload |
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Definition
| INCREASES CO, but decreases cardiac work!! artery more dilated so blood can go through more easily and heart doesn't have to push as hard |
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Term
| effect of decreasing preload |
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Definition
| decreases CO, less blood in ventricle so doesn't have to pump as hard |
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Term
| ADE of organic nitrites/nitrates |
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Definition
| due to excessive vasodilation: HA, hypotension, dizziness, reflex tachycardia |
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Term
| drug interactions for organic nitrites/nitrates |
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Definition
| PDE 5 inhibitors (viagra) should NOT be used in conjunction with org nit/ate b/c REALLY inc cGMP and cause dramatic reduction in BP!!! |
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Term
| other consideration for Nitrates/nitrites |
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Definition
| TOLERACE if sustained high plasma nitrate concentration. (maybe b/c of reduced ability of SM to convert nitroglycerin to NO, less thiol groups reflex SNS and renin ang system and supreroxide generation. to prevent remove patch for at least 12-14 hrs a day!!! |
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Term
| indications for org nit/ate |
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Definition
| angina (all), CHF (nitroglycerin, isosorbide dinitrate), Non-st segment elevation MI and acute MI |
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Term
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Definition
| bind to B1 receptors and dec. HR and contractility. therefore decreasing workload of the heart (inhib Gs= dec cAMP and dec Ca for contraction) |
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Term
| Nifedipine effects on coronary flow |
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Definition
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Term
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Definition
| strongest activity on cardiac nodal tissues, good effect on vasodilation too. |
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Term
| Ca2+ channel blockers MOA |
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Definition
aterial dilation: decreasesd afterload, dec cardiac work, reduced o2 demand. LITTLE effect on most venous beds
-actions on cardiac cells: verapamil and diltiazem dec rate of SA pacemaker and slow AV conduction, |
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Term
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Definition
| Verapamil and B blocker can cause AV block/depression of vent function!! use of verapamil to treat digitalis contraindicated. NEVER USE B-bLOCKER WITH non-DHP Ca channel blocker |
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Term
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Definition
| fatty acid oxidation inhibitor. blocks trans-cell late Na+ current and blocks NA+ depending Ca+ channels--> preventing Ca+ overload. ( to generate ATP heart uses fatty acids and glucose metabolism and amino acid metabolism, this drug shifts the metabolism of fatty acids to glucose so heart uses more glycolosis which doesn't require oxygen. can also blcok sodium current. inc sodium inside stim na/ca exchanger--> this drug BLOCKS sodium entry so ca doesn't enter and less contractility= less o2 demand |
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Term
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Definition
| inc QT interval, dizziness, HA, constipation, nausea/vomiting |
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Term
| ranolazine drug interactions |
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Definition
| CYP3A inhib: diltiazem, verapamil and grapefruit juice (don't use), inhib of p-glycoprotein (amiodorone, clarithromycina nd cyclosporin) don't use or will inc concentration of p-glycoprotein and inc toxins out of cells, and risk additive QT prolongation (quinidine class 1a and amiodorone class 3, dofetilide, sotolol don't sue) |
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Term
| indication for ranolazine |
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Definition
| chronic stable angina refractory to other antianginal drugs, acute coronary syndrome, unstable angina, non-ST elevation myocardial infaction (NSTEMI) |
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Term
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Definition
| blocks platelet aggregation/stops clotting |
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