Antianginals Flashcards
(36 cards)
examples of drugs metbaolized to nitric oxide
nitroglycerin
dinitrate
example of type5 phosphodiesterase inhibitor
sildenafil
examples of dihydropyridines
nifedipine
amlodipine
felodipine
examples of non-dihydropyridines
verapamil
diltazem
describe stable angina
fixed narrowing of teh coronary artery
onse associated with a given level of activity - predictable
descibe unstable angina
onset not predictable could be at rest
related to coronary atherosclerotic plaque rupture, dislodged clots
describe vasospastic angina
occurs at anytime
spasms of coronary artery
risk factors for angina
smoking dyslipidemia diabetes hypertension sedentary obesity stress family history
four treatments for angina
nitrates/nitrites
beta blockers
calcium channel blockers
ASA
what two ways can nitroglycerin be used and what are the formulations
acute pain - sublingual
prevent pain with exercise - patch, oral
how can isosorbide dinitrate be used and what are the formulations
prophylactically to prevent pain with exercise
sublingual and oral
what does nitric oxide do
increase cGMP which mediates dilation
nitrate mechanism of action
metabolized to nitric oxide
relax veins and arteries
coronary steal prevented
result of relaxing veins
venodilation
decrease preload
decreased filling pressure
decreased myocardial oxygen demand and less decrease in endocardial flow during systole
define endocardium
blood flow only during diastole
define pericardium
blood flow during diastole and systole
what is coronary steal
beyond to occlusion there is maximal dilation and reflux dilation in the healthy area steals the blood from the ischemic area
how is coronary steal prevented by nitrate
effects the larger arterial vessels more than the smaller so blood flows to bother healthy and ischemic regions
why is it best to not use nitrates over night
tolerance develops
adverse effects of nitrates
orthostasis
throbbing headache
reflex activation of SNS
salt and water retention
what is the double product
nitrates decrease oxygen demand but do not increase the supply
nitrates are light and heat sensitive how can you tell if they are potent
tingling sensation should be felt under the tongue
what does aldehyde dehydrogenase ALDH2 do
convert nitrate to nitric oxide
breakdown aldehyde associated with alcohol metabolism
why are most asians poor responders to nitrates and how can you tell if they will be
decreased ALDH2
if get a flushed response to alcohol
