Angina + Asthma + Histamine

Question 1

Disruption of stable plaque can cause these 4 processes

Answer 1

Platelet Adhesion
Fibrin Deposition
Thrombus Formation
Closure of blood vessel

Question 2

Ration of lack of oxygen leading to build up of acids and pain

Answer 2

Angina

Question 3

Factors that determine the progress of CAD

Answer 3

Concentration of lipid
Endothelial function
Blood pressure
Activity of inflammatory system
Reactivity of pro and anti-inflammatory systems

Question 4

Is the primary symptom of ischemic heart disease caused by imbalance of myocardial Oxygen supply and demand

Answer 4

Angina Pectoris, Also known as chest pain

Question 5

What does INOCA mean?

Answer 5

Ischemia with Non Obstructive Coronary Artery

Question 6

Happens when the arteries are pinched during systole

Answer 6

Myocardial Bridge

Question 7

Determinants of myocardial oxygen

Answer 7

Wall stress
Heart rate (Chronotropy)
Contractility (Inotropy)

Question 8

Determines left ventricular systolic wall stress

Answer 8

Arteriolar tone

Question 9

Determines right ventricular diastolic wall stress

Answer 9

Venous tone

Question 10

Steps in relaxation of smooth muscle

Answer 10

Increase cGMP & cAMP
Decrease intracellular Calcium
Stabilizing Depolarization

Question 11

Proportion of blood flow and arterial radius

Answer 11

Inversely proportional - As blood flow increases, artery radius decreases

Question 12

Pain in exertion and emotional stress. Characterized by build up of plaque within the endothelium and increase in myocardial oxygen demand

Answer 12

Stable Angina

Question 13

Rupture of atherosclerotic plaque causing platelet adhesion and aggregation. More thinner capsule are vulnerable

Answer 13

Unstable Angina

Question 14

Focal or diffuse vasospasm episodically. Endothelial dysfunction is one of the proposed mechanism causing vasospasm

Answer 14

Variant/Prinzmetal/Vasospastic Angina

Question 15

This is a characteristic feature of Acute Coronary Syndrome and would classify it as Unstable Angina

Answer 15

Resistance to Nitrates

Question 16

Activates the soluble isoform of guanylyl cyclase increasing intracellular cGMP thereby relaxing the smooth muscle

Answer 16

Organic Nitrates

Question 17

Activation of guanylyl cyclase through NO also has an effect on the…

Answer 17

Bronchi and GI tract, causing relaxed breathing and defacation

Question 18

These PDE5 inhibitors can potentiate the action of nitrates causing excessive vasodilation

Answer 18

Sildenafil
Tadalafil
Vardenafil

Question 19

This dose of NO dilates veins and conductance arteries

Answer 19

Low dose (Small and medium arteries not affected)

Question 20

This dose of NO venodilates causing decreased venous return leading to a fall in left and right ventricular chamber size and end-diastolic pressure, reduced wall stress, and reduced cardiac o2 demand. But may cause flushing and headache

Answer 20

Low to Medium Dose (Chronotropy unchanged, PVR and CO slightly reduced)

Question 21

This dose increases venous pooling and decreases arteriolar resistance causing hypotension-like symptoms and Bezold-Jarish reflex

Answer 21

Higher Dose

Question 22

The action of nitrates are?

Answer 22

Reduce preload
Dilation of Pulmonary vascular resistance
(Some reduction of afterload)

Question 23

Powerful stimulus for coronary vasodilation

Answer 23

Ischemic Heart Disease

Question 24

These non-selective vasodilators can cause Steal Phenomenon redistributing blood flow away from ischemic myocardium

Answer 24

Adenosine

Dipyridamole

Question 25

Used as a stress test to provoke angina and diagnose ischemia

Answer 25

Dipyridamole

Question 26

A function of dosage and frequency use due to prolonged treatment

Answer 26

Tolerance

Question 27

Mechanism of Tolerance

Answer 27

Volume expansion Neurohumoral activation Cellular depletion of SH groups Generation of free radiacals

Question 28

How to avoid tolerance of nitrates?

Answer 28

Interrupted treatment of 8-12 hrs/day | Avoid high doses

Question 29

Dosing of nitrates for patients with increased left ventricular filling pressure

Answer 29

Take nitrates at night

Question 30

Produces NO during sexual arousal

Answer 30

Cells of corpus cavernosum

Question 31

PDE5i approved in patients with pulmonary hypertension

Answer 31

Sildenafil

Question 32

PDE5i with longest half-life and longer onset of action

Answer 32

Tadalafil

Question 33

Vascular response from highest to lowest from nitrates

Answer 33

Veins > Arteries

Question 34

Nitrate vasodilation from highest to lowest reaction in epicardial coronary arteries

Answer 34

Eccentric > Concentric

Question 35

This class of anti-angina causes relaxation of smooth muscle by inhibiting calcium influx. Has high first pass effect, high plasma protein binding, and extensive metabolism

Answer 35

Calcium Channel Blockers

Question 36

Dihydropyridine CCB

Answer 36

``` Amlodipine Felodipine Lercanidipine Nicardipine Nifedipine Nisoldipine Isradipine ```

Question 37

Non-dihydropyridine

Answer 37

Verapamil | Diltiazem

Question 38

Voltage gated channel sensitive to dihydropyridines and binds to Alpha 1 subunit

Answer 38

L-type

Question 39

Verapamil binds to what segment of the L-type channel?

Answer 39

Transmembrane IV, Domain S6 (IVS6)

Question 40

Diltiazem binds to what L-type channel?

Answer 40

Cytoplasmic bridge and Domain 3 (IIIS)

Question 41

This CCB does not affect the rate of recovery of the slow Ca channel. It has a negative chronotropic effect

Answer 41

Nifedipine

Question 42

Reduces magnitude of calcium entry and rate of recovery of the channel. Depresses SA and slows AV node conduction used for the treatment of SVT, Hypertrophic cardiomyopathy, Prophylaxis for migrane, Second choice for asthmatic and depression patients

Answer 42

Verapamil

Question 43

Used in patients with neurological deficits secondary to cerebral vasospasms?

Answer 43

Nimodipine

Question 44

Provides symptomatic relief in Raynaud's

Answer 44

Nifedipine Diltiazem Amlodipine Felodipine

Question 45

When is oral and IV veramapil used?

Answer 45

Oral- Patients without HF | IV- Patients with HF

Question 46

Toxicity of CCB as a result of increase hydrostatic pressure in lower extremities

Answer 46

Peripheral toxicity

Question 47

Synthetic derivative of papaverine

Answer 47

Verapamil

Question 48

Only class effective in exertion or effort angina. Has negative inotropic and chronotropic effect

Answer 48

Beta blockers

Question 49

This phenomenon increases coronary collateral resistance and prevents blood from being shunted away from the ischemic myocardium

Answer 49

Reverse steal or Robin Hood Phenomenon.

Question 50

Recommended as first line treatment for patients with stable CAD, but not useful for prinzmetal angina

Answer 50

Beta blockers

Question 51

These beta blockers are standard for the treatment of angina without intrinsic sympathomimetic activity

Answer 51

Beta 1 selective/ Beta 1 Blockers