25 - Pharm of Angina

Question 1

which type of angina is not relieved generally by nitro?

Answer 1

unstable

Question 2

which intracellular messengers increase vascular smooth muscle relaxation

Answer 2

cAMP and cGMP both inc MLCphosphatase > relaxation

Question 3

NO causes vasodilation by

Answer 3

inc cGMP > inc MLCphosphatase > relaxation

Question 4

3 ways in which nitrates are good for improving myocardial oxygenation

Answer 4

dilate coronary arteries > direct inc in O2 supply
dec afterload by dilating systemic arteries > dec O2 demand
dec preload by dilating veins > dec O2 demand

Question 5

isosorbide dinitrate

Answer 5

longer acting nitrate (HL 1-4 hrs)

Question 6

nitroprusside warning

Answer 6

watch for CN poisoning

Question 7

nitrates metab

Answer 7

all metabolized in liver

Question 8

problem in dosing long term nitrate use

Answer 8

nitrate tolerance - dec formation of NO due to enzyme overload, reduced bioactivity, or activation of RAAS could cause it

prevent by having 7-12 hr nitrate free pd daily

Question 9

c/i for nitroglycerin

Answer 9

severe anemia (hemodilution)
hypotension
acute MI (although still used by many)
inc ICP (already causes it to go up due to dilation)
constrictive pericarditis
pericardial tamponade
restrictive cardiomyopathy
taking PDEs (ex viagra)

Question 10

why are nitrates and PDEs contraindicated together?

Answer 10

NO inc cGMP, PDEs prevent cGMP degradation > too much dilation > hypotension > reflex tachy

Question 11

SEs of nitrates

Answer 11

throbbing HA
flushing
hemodilution, methemoglobinemia
prolonged bleeding time
thrombocytopenia
CN poisoning (w/ nitroprusside)
reflex tachy
paradoxical HTN
arrhythmias

Question 12

SEs of beta blockers

Answer 12

bronchoconstriction
bradycardia
hypotension
vivid dreams
~10% men complain of sexual impairment

Question 13

3 kinds of CCBs

Answer 13

-dipines - blood vessels
diltiazem - vessels = heart
verapamil - heart

Question 14

how do CCBs help angina?

Answer 14

dec HR / conduction velocity
dilate blood vessels
dec afterload

Question 15

ex of K channel openers

Answer 15

-dil

monoxidil, pinacidil, nicorandil

Question 16

how do K channel openers work in the context of angina?

Answer 16

K channels hyperpolarize cell > close Ca channels > same effect as CCBs

Question 17

SEs of K channel openers

Answer 17

flushing, HA, hypotension, reflex tachy, hirsutism

Question 18

other use for monoxidil

Answer 18

rogaine! hair growth for bald dudes

Question 19

hydralazine

Answer 19

direct arterial vasodilator
mech unknown
not first line b/c leads to reflex tachy and commonly drug induced SLE

Question 20

endogenous opposition to NO

Answer 20

endothelin - vasoconstrictor

Question 21

endothelin antagonist

Answer 21

Bosentan

Question 22

what is Bosentan used for

Answer 22

(endothelin antag) used for severe pulm HTN