Angina

Question 1

Types of Angina (3)

Answer 1

1 atherosclerotic
2 vasospastic
3 unstable

Question 2

Determinants of cardiac oxygen requirement (2)

Answer 2

1 Diastolic factors
2 Systolic factors

both lead to cardiac fiber tension

Inc myocardial O2 req

Question 3

Diastolic factors (2)

Answer 3

Blood volume

Venous tone

Question 4

Systolic factors (4)

Answer 4

Peripheral resistance
Heart rate
Heart force
Ejection time

Question 5

Goals for angina management(4)

Answer 5

Inc O2 delivery
Reduce O2 req
Inc efficiency of O2 utilization
Myocardial revasc

Question 6

Releases nitric oxide in smooth muscle cells through mitochondrial enzyme aldehyde dehydrogenase 2 ALDH2

Answer 6

Nitrates

Question 7

Given SL, transdermal, IV, oral

High first pass effect

Answer 7

Nitroglycerin

Question 8

Nitrate given orally

Answer 8

Isosorbide mononitrate

Question 9

Nitrate given SL, orally

Answer 9

Isosorbide dinitrate

Question 10

Nitrate inhaled

Answer 10

Amyl nitrite

Question 11

Activates nitrite to nitric oxide by ALDH2/3

NO combines with guanylyl cyclase 
Inc CGMP
PGE prostaglandin production
PGI prostacyclin production
Diminished vascular smooth muscle activation
Vasodilation of arteries and veins

Answer 11

Nitrates

Question 12

Nitrate tolerance attributed to (3)

Answer 12

Sulfhydryl group - cysteine
Inc O2 free radicals
Dec calcium generated polypeptide cgrp (vasodilator)

Question 13

Nitrates relieve angina by

Answer 13

Inc venous compliance
Dec ventricular preload
Relaxation of veins
Dec CO promote diastole inc CBF
Relaxation of bronchi GI
Inc CGMP Dec platelet aggregation

Question 14

Nitrate SE

Answer 14

OH
syncope
headache
Temporal pulsation

Question 15

Nitrates CI in

Answer 15

Inc ICP

IF TOLERATING GIVE CYSTEINE

Question 16

Nitrates cause

Answer 16

compensatory tachycardia, contractility and salt and water retention

Question 17

Nitrate uses

Answer 17

Angina

Cyanide poisoning

Question 18

Nitrates can promote lethal hypotension if combined with

Answer 18

PDE5 inhibitors
Sildenafil
MI

Question 19

Nitrates cause toxicity of

Answer 19

Methemoglobinemia

Question 20

Alpha 1 recetor affinity with more effect on smooth muscle vs nondihydropiridine bec of K channel

Answer 20

Nifedipine

Question 21

Dec transmembrane Ca current leading to
relaxation of vascular, bronchial, GI and uterine smooth muscles
dec in cardiac contractility
dec in SA node/AV node (hr)

Answer 21

Ca ch blocker L type

Question 22

Ca ch blockers reduce BP but induce

Answer 22

Reflex tachycardia (Nifedipine)

Question 23

Dec heart rate and contractility

Blocks calcium dependent conduction in AV node

Answer 23

Non Dihydro Ca ch blocker

Question 24

Used as prophylaxis for effort and vasospastic angina
HTN
SVT
Migraine 
Preterm labor
Stroke/SAH
Raynaud’s

Answer 24

Calcium ch blocker

Question 25

Ca ch blocker SE (4)

Answer 25

``` AV block nondihydropiridine MI (short acting Nifed) Constipation Bradycardia Pretibial edema Flushing Dizziness ```

Question 26

Dec cardiac workload (BP, HR, contractility) Dec O2 demand (reduced ischemic time) Inc heart size Prolonged ejection

Answer 26

Beta blockers

Question 27

Beta blockers inc EDV and ejection time so they are best balanced by

Answer 27

nitrates due to inc O2 req

Question 28

Prophylactic tx of exercise induced angina Dec mortality in px with recent MI Improves survival with stroke and HTN

Answer 28

Beta blockers

Question 29

Beta blocker SE (4)

Answer 29

Erectile dysfunction Hypoglycemia Worsening claudication Fatigue, insomnia Avoid in asthmatics, bradycardics

Question 30

Reduces late sodium current INa that facilitates Ca entry via Na-Ca exchanger dec intracell Ca and prolonging QT interval

Answer 30

Ranolazine

Question 31

Dec diastolic tension cardiac contractility and work

Answer 31

Ranolazine

Question 32

Ranolazine SE

Answer 32

Prolonged QT interval (CAD) | Shortened QT in long QT syndrome

Question 33

Nicotinamide nitrate ester Dec preload and afterload Myocardial protective by activating cardiac K ATP ch

Answer 33

Nicorandil

Question 34

Inhibits fatty acid oxidation in myocardium PostMI and angina Drug class

Answer 34

Trimetazidine | PFOX inhibitor

Question 35

How is trimetazidine able to improve metabolic status of ischemic tissue

Answer 35

By partial inhibition of enzyme long chain 3 ketoacetyl thiolase LC-3KAT

Question 36

Inhibits xanthine oxidase contributing to oxidative stress and endothelial dysfunction

Answer 36

Allopurinol

Question 37

High dose allopurinol prolongs the

Answer 37

Exercise time in px with angina

Question 38

Relatively selective If funny Na ch inhibitor | Reduces HR by inhibiting hyperpolarization activated Na ch in SA node but not in afib

Answer 38

Ivabradine

Question 39

Reduces angina with efficacy similar to Ca ch blocker and Beta blocker

Answer 39

Ivabradine

Question 40

Inhibitor of smooth muscle Rho kinase

Answer 40

Fasudil

Question 41

Family of enzyme inhibiting vascular relaxation

Answer 41

Rho kinase (ROCK)

Question 42

Reduces coronary spasm in experimental animals

Answer 42

Fasudil

Question 43

CAD Medical Therapy (7)

Answer 43

``` Antiplatelet Lipid lowering ACEI Beta blocker Nitrate Ca ch blocker Anticoagulation ```

Question 44

Intermittent claudication pain occuring in skeletal ms legs during exercise and disappears with rest Chronic ischemic ulcers

Answer 44

PAD

Question 45

PDE3 Inhibitor, selective antiplatelet and vasodilator for PAD Inc exercise tolerance in pxs with severe claudication

Answer 45

Cilostazol

Question 46

Xanthine derivative reducing viscosity of blood and inc deformability of RBC allowing efficient blood flow in obstructed areas

Answer 46

Pentoxyfylline

Question 47

Determinants of vascular tone (4)

Answer 47

1 Inc CGMP (dephosphorylation of MLC NO) 2 Dec intracellular Ca (vasodilation, Ca ch blocker Beta blocker) 3 Inc K efflux permeability (opening of K ch prevents depolarization, Minoxil, Diazoxide) 4 Inc CAMP vascular smooth muscle inactivates MLCK(Beta 2 agonist, Fenoldopan D1)

Question 48

Inhibits beta oxidation of FFA Cytoprotective that normalizes blood flow in low flow ischemia

Answer 48

Trimetazidine