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Pharmacology - Winter > 3 - Anti-anginals > Flashcards

3 - Anti-anginals Flashcards

(58 cards)

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1
Q

What is a myocardial infarction?

A

Damage to the muscular layer of the heart, so pumping action is compromised, leading to heart failure

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2
Q

What causes a myocardial infarction?

A

Severe obstruction of the blood supply causing nutrient and oxygen deficiency, leading to ischemia

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3
Q

What is anginal pain a symptom of?

A

Ischemic heart disease

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4
Q

When does angina pectoris occur?

A

When there is insufficient oxygen to meet the requirement of the heart

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5
Q

What are some risk factors for angina pectoris?

A
  • Male
  • Older age
  • Post-eating (normally fatty meal)
  • Physical exertion
  • Smoker
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6
Q

What is stable angina?

A

When the px knows when it will occur and can take steps to prevent it

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7
Q

What are the 3 types of angina?

A

1) Stable
2) Unstable
3) Vasospastic or prinzmetal

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8
Q

What are some inducing factors of stable angina?

A

Atherosclerosis and exercise, emotions

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9
Q

What are some inducing factors of unstable angina?

A
  • Atherosclerosis w/ unstable plaque (Plaque ruptures)

- Can occur at rest

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10
Q

What is an inducing factor of vasospastic or prinzmetal angina?

A
  • Vasospasm

- Can occur at rest or in the morning when high epinephrine release or high serotonin levels

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11
Q

What is the test for prinzmetal angina?

A

Vasoconstrictor is given during cardiac catheterization, after no atherosclerosis is visualized

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12
Q

What are the 2 factors of angina pectoris that drugs may affect?

A
  • Oxygen demand of tissues

- Oxygen supply to tissues

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13
Q

How can you increase oxygen supply?

A
  • Nasal oxygen
  • Increase coronary flow and distribution through vasodilation of certain blood vessels (increasing flow isn’t enough, need to increase distribution to make sure it reaches ischemic areas)
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14
Q

If arteries are constricted, afterload will ______

A

Increase

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15
Q

How can oxygen demand be decreased?

A
  • Less work by the heart (rest)
  • Lessen preload or venous return (venodilate w/ drugs like nitrate)
  • Decrease work by the heart by decreasing afterload/BP
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16
Q

What determines contraction of smooth muscle cells?

A

Calcium that initiates actin-myosin interaction

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17
Q

Which substances inhibit contraction of smooth muscle? How?

A
  • Cyclic AMP and cyclic GMP

- Lower smooth muscle cell calcium

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18
Q

What will be the result if a drug increases cyclic GMP or cyclic AMP?

A

Relax smooth muscle and vasodilate

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19
Q

Do cyclic GMP and cyclic AMP relax cardiac muscle?

A

Cyclic GMP does, cyclic AMP does not

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20
Q

Which types of drugs can be used to treat or prevent angina?

A
  • Vasodilators
  • Agents that decrease cardiac work
  • Agents that decrease calcium load
  • Agents that prevent thrombus formation
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21
Q

What are the types of nitrates? Which has the shortest duration of action?

A
  • Amyl nitrate (shortest duration)
  • Nitroglycerin
  • Isosorbide dinitrate (longest duration)
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22
Q

How do nitrates help w/ angina?

A
  • Nitrates increase nitrites, which increase nitric oxide, which increases cyclic GMP, and causes smooth muscle relaxation
  • Primarily affects venous system, so preload is decreased, and so is oxygen demand
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23
Q

_____ route of nitrates is preferred

A

Sublingual

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24
Q

How are nitrates excreted?

Study These Flashcards
A

By kidneys as glucouronide

25
What is required to release nitric oxide from nitrates?
Esterases
26
Esterases are more abundant in ____ than _____
Veins than arteries
27
Do nitrates have a direct affect on cardiac muscle?
No, affects smooth muscle and possibly platelets
28
How does nitric oxide increase cGMP?
NO reacts w/ -SH containing receptor of guanyl cyclase
29
What affect do nitrates have on angina that is different from someone w/o angina?
- In normal px, there is an increase in coronary flow | - In angina, there is redistribution of flow to ischemic region by opening of collateral vessels w/ nitrates
30
What are the problems w/ nitrate use?
- Postural hypotension - Reflex symp activation (tachycardia, venoconstriction) - Hypoxia and death due to methemoglobin formation (rare from therapeutic doses) - Tolerance w/ long acting preparations
31
What can be done to prevent nitrate tolerance?
8 hour nitrate free period
32
What is an important drug interaction w/ nitrates?
- Sildenafil (viagra) | - Selective inhibitor of cGMP-specific phosphodiesterase type 5, which is required for smooth muscle relaxation
33
What are side effects of sildenafil?
- Mild headache and flushing | - Dyspepsia
34
What are the 3 types of calcium channel blockers?
1) Dihydro-pyridines 2) Phenyl-alkylamines 3) Benzothiazepines
35
What do calcium channel blockers do?
Convert the channel into a closed state, and thus block calcium influx and induce relaxation
36
Which smooth muscle do calcium channel blockers mostly affect?
Arterioles more sensitive, little effect on veins
37
Do calcium channel blockers cause postural hypotension?
Not normally
38
What affect do calcium channel blockers have on cardiac muscle?
- Impulse generation in SA node and AV nodal conduction may be blocked by all types - Direct effect on myocardial cell calcium influx and reduces oxygen demand - Protects from excessive loading of ischemic cell w/ calcium, reducing incidence of arrhythmias and infarct size
39
What are the uses of calcium channel blockers?
- Angina (esp. prinzmetal), hypertension - Migraines, Raynaud's syndrome - Hypertrophic cardiomyopathy and cardiac arrhythmias
40
Which calcium channel blocker is preferred for unstable angina?
Verapamil
41
What are some minor side effects of calcium channel blockers?
Constipation, edema, flushing
42
What can happen if calcium channel blockers are used w/ propranolol?
Could be a cardiac depressant at lower concentration than usual
43
Which calcium channel blocker is preferred for atrial fibrillation in the presence of hypotension?
Verapamil
44
What is the concern of verapamil with digoxin?
Verapamil can elevate concentration of digoxin in blood
45
What are the affects of beta-adrenergic blockers in angina?
- Reduce work of the heart and oxygen demand - Reduce BP - Reduce frequency and severity of angina - Reduce mortality
46
For angina, beta blockers are used with _____
Nitrates
47
What are beta blockers contraindicated w/?
- Asthma - Diabetes - Peripheral vascular diseases (Raynaud's syndrome)
48
Why are beta blockers contraindicated in diabetes?
Px won't be able to tell when they are hypoglycemic
49
Are all vasodilators useful for angina? Why?
- No, many are arteriolar dilators which can cause rebound symp stimulation and are harmful - "Coronary steal" - by dilating arteries to normal tissues, some vasodilators can steal blood which could otherwise perfuse ischemic areas
50
What are the drugs used for coronary vascular disease?
- Nitrates - Calcium channel blockers - Beta adrenergic blockers
51
What can be used for revascularization in coronary vascular disease?
- Clot busters (thrombolytics) - Coronary stents - Ballon angioplasty - CABG (coronary artery bypass grafting)
52
Which enzyme converts NADPH + L-arginine to NO?
Nitric oxide synthetase
53
What are the 3 types of nitric oxide synthetase? Where is each form found?
1) Isoform 1 (nNOS) - neurons, epithelia 2) Isoform 2 (iNOS) - macrophages, inducible by LPS 3) Isoform 3 (eNOS) - endothelium
54
What is the action of nitric oxide at low concentrations?
Vasodilation
55
What is the action of nitric oxide at high concentrations?
Kill bacteria, inhibit Cyt P450, inflammation
56
What are some inhibitors of nitric oxide?
- Aminoguanidines | - Arginine analogues
57
What are the uses of nitric oxide donors?
- Angina - Pre-eclampsia - Pulmonary hypertension - Hypertensive emergencies - Respiratory distress
58
What are the uses of nitric oxide inhibitors?
- Arthritis - Inflammatory liver diseases - Septic shock

Pharmacology - Winter (18 decks)

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