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Flashcards in 41Coronary Heart Deck (31)
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1

What are the 4 general things we do to decrease O2 demand and increase O2 supply?

decrease work of heart
inhibit platelet aggregation/thrombus
prevent or inhibit vasospasm
mechanical interventions

2

What are the 4 main antianginal agents?

nitrovasodilators
beta adrenergic blockers
calcium channel blockers
ACEI/ARB

3

What happens to heart rate contractility with nitrovasodilators? Wall stress and MVO2? after load? preload?

1. reflex increase in contractility
2. decrease wall stress and MVO2
3. decrease preload
4 decrease afterload
[this all reduces O2 demand]

4

What nitovasodilator goes through the mitochondria to become NO? smooth ER? Which one does not need metabolized?

1. GTN
2. ISDM,ISMN
3nitroprusside

5

What are the 3 main mechanisms of actions for nitrovasodilators?

Relaxes large arteries
Relaxes all veins
inhibit platelet aggregation

6

What happens if you don't take off your transdermal nitrate patch at night?

build tolerance quickly

7

Does isosorbide denigrate or isosorbide mononitrate have the shorter half life?

ISDN-administered 3-4 times daily

8

What is the order of headache intensity for the nitrates?

GTN>ISDN>ISMN [it is a sign that they are working!!]

9

When are nitrates contraindicated?

erectile dysfunction pills- PDE5

10

What does NO and nitrates enhance?

sGC which takes GTP to cGMP

11

Which PDE5 inhibitor has the longest half life? shortest? longest onset? shortest onset?

1. tadalafil 2. vardenafil/sildenafil
3. sildenafil 4. avanafil

12

What is the mechanism of action of beta adrenergic receptor agonists? beta 1 blocker effects? beta 2 blocker effects

1. inhibit sympathetics
2. decrease HR and contractility, decrease renin
3 potentiate alpha adrenergic effects- vasoconstrict

13

beta 2 selective antagonists have receptors where?

blood vessels, bronchioles and pancreas

14

Can beta blockers cause impotence?

yes

15

Do beta blockers cause hyperglycemia and hyperlipidemia?

hypoglycemia and hyperlipidemia

16

Do beta blockers prolong survival in patients with compensated HF? what may worsen HF?

1. Yes by decreasing MVO2
2. negative ionotropic effects

17

What is the rebound phenomenon with beta receptor antagonists?

worsening of MI with abrupt discontinuation of use due to up regulation of beta adrenergic receptors

18

What do calcium channel blockers do to vasculature? cardiac?

1. relax arteries- minimal vein effect
2. decreases contractility of myocytes

19

How do calcium channel blockers reduce O2 demand?

decrease arterial pressure
decrease contractility
decrease heart rate

20

How do calcium channel blockers increase O2 supply

dilate epicardial arteries and stenoses
prevent vasospasm

21

Is nifedipine good in acute MI?

No, can worsen

22

Are calcium channel blockers better for secondary MI prevention than Beta blockers?

No

23

should we use valium channel blockers in heart failure?

no--due to negative inotropic effect

24

Do inhibitors of RAS prevent secondary MI?

Yes

25

When should we avoid use of ranolazine?

in patients with prolonged QT intervals or hepatic involvement

26

Does ranolazine have a chronotropic or isotropic effect? does it effect heart rate and blood pressure? what does it improve?

No, no, exercise tolerance

27

What do we treat an acute angina attack with?

sublingual nitrates and aspirin

28

What are the 2 main steps we try to do in order to treat chronic unstable CHD, Angina?

Reduce myocardial oxygen demand
stabilize atherosclerotic plaque

29

Which platelet inhibitor has the fewest drug interactions?

plasugrel

30

What do we treat acute unstable CHD MI with?

MONA
morphine, oxygen, nitroglycerin, aspirin