Term
| Metabolic factors formed from hypoxic myocardial tissues? |
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Definition
| Adenosine, Lactate, acetate, H+, CO2 |
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Term
| Endothelial factors released from hypoxic cardiac tissue including vasodilators and vasoconstrictors? |
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Definition
vasodilators: NO, EDHF, and PGI2 (prostacyclin)
Vasoconstrictors: endothelin |
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Term
| Differentiating factors of variant angina? |
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Definition
| it is a typical angina pain that occurs at rest and usually during the same time of day. Caused by coronary spasm and not blockage. |
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Term
Treatment choices for stable angina?
Other consideration in treating stable angina? |
|
Definition
Long acting nitrates
Beta Blockers
Calcium Channel Blockers
You must treat the underlying cause --> administer statins and prevent thrombus formation --> aspirin |
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Term
|
Definition
amyl nitrate
glyceryl nitrate
isosorbide dinitrate
isosorbide mononitrate |
|
|
Term
Indications for nitrates?
5 things |
|
Definition
termination of acute anginal attack**
Prophylaxis for stress induced attacks
pts w/ frequent symptoms
pts who cannot take Beta blockers or Ca channel blockers
treatment of cyanide poisoning |
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Term
|
Definition
Exogenous nitrates or NO -> increase in guanyl cyclase -> increase cGMP -> smooth muscle relaxation -> vascular dilation
reduce myocardial O2 consumption via reduced work load through venodilation and arteriole dilation.
Increase O2 supply via dilation of collateral circulations.
Inhibits platelet aggregation via inhibition of thromboxane synthetase. |
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|
Term
|
Definition
flushing nausea
Throbbing headace (meningeal artery vasodilation)
orthostatic hypotension
reflex tachycardia (combine w/ beta blocker to prevent)
syncope, dizziness
high doses -> methemoglobinemia |
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|
Term
| How do you decrease or avoid Nitrate side effects and tolerance? |
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Definition
| by providing a nitrate fee period such as not taking the drugs before bedtime |
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|
Term
| contraindications to administering nitrates |
|
Definition
| pt on migraine medication or if they are taking other vasodilators such as viagra or other PDE5 inhibitors. |
|
|
Term
| What is the nitrate of choice for quick relief during exertion? |
|
Definition
| sublingual tablets or sprays |
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|
Term
| When are the longer acting nitrates indicated and what are they? |
|
Definition
| ISDN and ISMN are indicated when symptoms become more frequent and severe. |
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Term
| What is the main way that Beta blockers relieve stable angina? |
|
Definition
| by decreasing cardiac workload and o2 demand via stopping increases in heart rate and contractility |
|
|
Term
| Why would you combine nitrates w/ beta blockers? |
|
Definition
| to reduce the reflex tachycardia associated w/ nitrates |
|
|
Term
| Side effects of beta blockers |
|
Definition
| bronchospasm, bradycardia, fatigue, depression, rebound hypertension |
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|
Term
Name the three classes of L-type Ca channel blockers and examples of each?
Which specific channels do each class block? |
|
Definition
Dihydropyridines block vascular Ca channels: nifedipine and beperidil
Phenylalkylamines block cardiac Ca channels: verapamil
Benzothiazapines block both vascular and cardiac Ca channels: Diltiazem |
|
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Term
| is it ok to combine beta blockers w/ Ca channel blockers? |
|
Definition
|
|
Term
| Is it ok to combine Nitrates and calcium channel blockers? |
|
Definition
|
|
Term
| 4 other uses for calcium channel blockers? |
|
Definition
| PSVT, Reynauds syndrome, Migraines, Strokes |
|
|
Term
| What is the number 1 choice in relieving an acute variable angina attack? |
|
Definition
| nefedipine - relieves the coronary vasospasm |
|
|
Term
| Side effects of nefedipine? |
|
Definition
| headache, constipation (all Ca blockers), and gingival hyperplasia |
|
|
Term
| What is the difference between Beperidil and Nefedipine? |
|
Definition
| bepiridil (vascor) also blocks Na channels |
|
|
Term
| Side effects of beperidil? |
|
Definition
if combined w/ Beta blockers -> heart failure
Torsades or other arrythmias
Agranulocytosis |
|
|
Term
| Indications to use a phenylalkylamine? |
|
Definition
| stable or variant angina. |
|
|
Term
| Verapamil drug class and effects? |
|
Definition
| classed as a pheylalkylamine and decreases cardiac workload via slowing heart rate (slows AV conduction) and contractility. |
|
|
Term
| Side effects of verapamil? |
|
Definition
constipation and gingival hyperplasia.
Sinus bradycardia. |
|
|
Term
| Indications for Diltiazem administration? |
|
Definition
|
|
Term
| Side effects of benzothiazapines? |
|
Definition
diltiazem
Sinus bradycardia, AV block (if used w/ beta blockers), hypotension, edema |
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|
Term
| Name 8 side effects associated w/ all calcium channel blockers |
|
Definition
| 1. constipation 2. gingival hyperplasia 3. heart failure w/ beta blockers 4. bradycardia 5. nausae/flushing 6. edema 7. reflex tachycardia 8. dizzines |
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|
Term
| Are beta blockers indicated in the treatment of variant angina? |
|
Definition
|
|
Term
| treatment choice in management of unstable angina? |
|
Definition
first of all, if they have ST segment changes, consider angioplasty
drugs of choice are beta-blockers w/ nitrates + anti-coagulants. |
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|
Term
| Post ACS, what drug is most indicated? |
|
Definition
| beta blockers. specifically B1 blockers |
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