(4) Smooth Muscle: Vasoactive (1.1-1.3) Flashcards

(44 cards)

1
Q

What enzyme do nitrates activate?

A

Guanylyl cyclase ⇒ ↑ cGMP

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2
Q

Describe the effect nitrates have on the vasculature

A

(1) Significant venous dilation
(2) Moderate dilation of large arteries

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3
Q

Which hemodynamic factor do nitrates predominantly affect?

A

Preload

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4
Q

Indications (3) : Nitrates

A

(1) Stable angina
(2) Prinzmetal angina
(3) Acute coronary syndrome

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5
Q

ROA: Nitroglycerin

A

Sublingual

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6
Q

ROA: Isosorbide Nitrate

A

Oral

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7
Q

When are nitrates contraindicated in the treatment of MI?

A

Right-sided MI

(Due to ↑ sensitivity to preload)

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8
Q

Why would β-blockers be given with nitrates?

A

Prevent reflex tachycardia

(Venous vasodilation ⇒ ↓ Preload ⇒ ↓ MAP ∴ Body compensates by ↑ HR)

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9
Q

How can nitrates cause hypoxia?

A

Oxidize heme Fe2+ → Fe3+

(Nitrates have many oxygens ∴ oxidizing agents ∴ oxidize iron)

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10
Q

How is nitrate tolerance avoided?

A

Nitrate free interval every day

(to avoid tolerance)

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11
Q

What drug class is an absolute contraindication to nitrates?

A

PDE-5 inhibitors

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12
Q

What type of heart disease are nitrates contraindicated in?

A

Hypertrophic cardiomyopathy

(↓ Chamber volume exacerbates outflow obstruction and mitral regurgitation)

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13
Q

What nerve is irritated during a migraine?

A

Trigeminal n.

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14
Q

What drug is first-line therapy for migraines?

A

Triptans

(i.e., Sumatriptan)

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15
Q

MOA: Triptans

A

(1) 5-HT1b agonist
(2) 5-HT1d agonist
* (Specifically on the meningeal vessels)*

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16
Q

What is the effect of stimulating vascular 5-HT1b and 5-HT1d receptors?

A

Vasoconstriction

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17
Q

What is the effect of stimulating 5-HT1b and 5-HT1d receptors on the trigeminal nerve?

A

prevents the release of vasoactive peptides

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18
Q

What is the effect of stimulating 5-HT1b and 5-HT1d receptors in the brain stem?

A

Inhibits pain pathway

19
Q

Adverse Effect: Triptans

A

Coronary vasospasm

20
Q

Contraindication: Triptans

A

Patients with angina

(Also are known to trigger Prinzmetal angina)

21
Q

Treatment: Acute cluster headache

A

Triptans + O2

22
Q

Name 5 options available for migraine prophylaxis

A

(1) Calcium channel blockers
(2) β-blockers
(3) Valproic acid
(4) Topiramate
(5) Tricyclic antidepressants

23
Q

Alprostadil is an analog of?

24
Q

Indications (2) : Alprostadil

A

(1) Erectile dysfunction
(2) Maintain patent ductus arteriosus
* (Second-line therapy for ED)*

25
Name 3 physiologic effects of PGE1
(1) Arteriolar vasodilation (2) ↑ Gastric mucus secretion (3) ↑ Uterine contraction * (Also prevents platelet aggregation)*
26
Which prostanoid keeps the ductus arteriosus open?
PGE1
27
Misoprostol is an analog of?
PGE1 *(Don't confuse with Mifepristone which is a progesterone antagonist)*
28
**Indications** (2) : Misoprostol
(1) Prevent NSAID-induced peptic ulcer (2) Induce contractions
29
What is the main side effect of Misoprostol?
Diarrhea *(Given its used as abortifacient, it likely causes uterine cramps too)*
30
Dinoprostone is an analog of?
PGE2 *(Dino is right of Dill pickle ∴ PGE2 instead of PGE1)*
31
**Indications** (2) : Dinoprostone
(1) Facilitate labor (2) Terminate pregnancy
32
Name 3 analogs of PGF
(1) Carboprost (2) Latanoprost (3) Travoprost
33
What is Carboprost used for?
Promotes uterine contraction *(↑ Uterine contraction ∴ controls postpartum hemorrhage and terminates pregnancy)*
34
What is Latanoprost used for?
↑ Aqueous humor _outflow_ *(∴ Useful for OPEN-angle glaucoma)*
35
What is the distinctive side effect of Travoprost?
Brown pigmentation of the iris *(Also occurs with Latanoprost)*
36
Who does idiopathic pulmonary hypertension most commonly manifest in?
Women 20-40 y/o *(As shown by the woman holding tennis rackets)*
37
Describe the side effects of PGI2 analogs
Consequences of vasodilation *(Hypotension, cutaneous vasodilation, flushing)*
38
Name 2 PGI2 analogs used to treat pulmonary hypertension
(1) Iloprost (2) Epoprostenol
39
**Suffix**: PDE-5 inhibitors
"-fil"
40
PDE-5 inhibitors increase the intracellular concentration of?
cGMP
41
**Indications** (2) : PDE-5 inhibitors
(1) Erectile dysfunction (2) Pulmonary hypertension
42
What is the major toxicity associated with Bosentan?
**_Fatal_** hepatotoxicity
43
**MOA**: Bosentan
Inhibits endothelin *(Boss stan ∝ Bosentan)*
44