Cardiovascular pharmacology IX Flashcards Preview

Year 2 Pharmacology > Cardiovascular pharmacology IX > Flashcards

Flashcards in Cardiovascular pharmacology IX Deck (14):
1

what is the typical cause of anginal pain?

release of bradykinin and adenosine onto nociceptive efferents

2

what are agents that decrease oxygen demand?

1. beta blockers
2. some calcium entry blockers
3. organic nitrates
4. calcium entry blockers

3

what are agents that increase oxygen supply?

1. vasodilators (especially calcium entry blockers)
2. statins
3. antithrombotics

4

what are the organic nitrates used to treat myocardial ischemia?

1. nitroglycerin
2. isosorbide dinitrate (ISDN)
3. isosorbide mononitrate (ISMN)

5

what is the MOA of nitrates?

1. prodrugs that must undergo denitrification by mitochondrial aldehyde reductase to yield NO
2. NO activates soluble GC increasing cGMP and cGK-1 activation
3. increased mitochondrial calcium uptake
4. decrease calcium influx
5. phosphorylation of MLCK - vasorelaxation

6

what are the pharmacokinetics of nitroglycerin?

1. hepatic and intravascular metabolism - very fast half life 1-4 minutes
2. sublingual and transdermal route

7

what are the pharmacokinetics of isosorbide dinitrate?

phasic, released form - QD dosing to avoid tolerance

8

what are the pharmacokinetics of isosorbide mononitrate?

1. does not undergo first pass hepatic metabolism - completely bioavailable
2. sustained, phasic release form - QD dosing - avoids tolerance

9

what are the pharmacodynamic effects of organic nitrates for myocardial ischemia?

1. potent vasodilation in veins - decreased ventricular volume and preload
2. no effect on peripheral vascular resistance
3. little or no effect on coronary resistance vessels - avoids coronary steal (shunting)
4. works to decrease work load rather than vasodilate

10

why is ISMN effective in the therapy of exertional angina?

phasic release form - effective plasma concentrations during the day

11

why are nitrates used in acute CHF?

1. dramatically lower filling pressure without adverse effects on systemic BP
2. in acute and chornic ischemia, organic nitrates can be therapy of choice

12

which drugs are good for African Americans with CHF especially resulting from systolic dysfunction?

ISDN and hydralazine combination

13

in people with MI and LV failure, why are nitrates a good choice?

decrease in preload due to venous dilation

14

what are the side effects of nitrates?

1. headaches
2. hypotension

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