Exam 1: Ischemia and CAS

Question 1

What type of angina is considered “Demand Ischemia”

Answer 1

Stable

Question 2

What are the characteristics of Stable Angina

Answer 2

occurs upon exertion
improves with rest
chronic yet stable coronary obstruction

Question 3

What are goals for the treatment of chronic/variant angina

Answer 3

dilate coronary arteries ( decrease afterload)
Decrease O2 demand
Decrease preload

Question 4

What does dilating coronary arteries do?

Answer 4

Decrease afterload “A”

Question 5

what does dilating veins do?

Answer 5

Decrease preload

Question 6

How do nitrates work?

Answer 6

Act on GC to increase cGMP to dephosphorylate MLC and cause venous relaxtion

Question 7

What do nitrates do to cGMP

Answer 7

Increase it

Question 8

Which drug acts on GC

Answer 8

nitrates

Question 9

How do CCBs work?

Answer 9

block L-type channels to prevent calcium influx that would otherwise activate calmodulin and cause contraction

Question 10

Which drug prevents the activation of calmodulin?

Answer 10

CCBs! (C)

Question 11

How do Beta blockers work?

Answer 11

they prevent the stimulation of the myocardium by epinephrine by preventing the release of calcium from the SR

Question 12

What is the target of CCBs and why? (veins or arteries)

Answer 12

Arteries! They lack the SR calcium stores that veins have making the CCB effective

Question 13

What state of the heart are cardiac cells able to be better perfused? (systole or diastole)

Answer 13

Diastole

Question 14

What does the decreased heart rate during exertion allow beta blockers to do?

Answer 14

prolong diastole

Question 15

what does ivabradine do?

Answer 15

prolong diastole and improve ventricular filling

Question 16

What is the goal of treating unstable angina

Answer 16

block thrombus formation (prophylaxis)

dissolve existing thrombus

Question 17

What does aspirin do?

Answer 17

Inactivates COX-1 to prevent TXA2 synthesis, preventing platelet aggregation

Question 18

What does heparin do?

Answer 18

binds to antithrombin to activate and propagate its effect of inactivating clotting factors

Question 19

How do P2Y12 antagonists work?

Answer 19

by irreversibly inhibiting P2Y12 to prevent Gp activation it prevents platelet aggregation

Question 20

Which drug classes causes reflex tachycardia?

Answer 20

nitrates and CCBs

Question 21

Which drug class prevents reflex tachycardia

Answer 21

beta-blockers (cause they slow HR)

Question 22

which drug class increases preload?

Answer 22

beta-blockers

Question 23

which drug class blocks increased preload?

Answer 23

nitrates! (circle of life baby)

Question 24

How does nitrate tolerance occur?

Answer 24

The inactivation of ALDH2 is what allows NTG to breakdown in to NO in the mitochondria but it there’s a limited supply so it needs time to re-synthesize

Question 25

What are late Na channels and why do they matter?

Answer 25

They try to respond to the low supply of ATP caused by low oxygen in ischemia by opening to fill the cells with Na and prolong depolarization time. This causes a retention of calcium in the cell which means less oxygen can get in and etc. etc. it's bad

Question 26

What drug blocks late Na channels?

Answer 26

Ranolazine! (replexa)

Question 27

What is dosing of Replexa?

Answer 27

500 - 1000mg bid

Question 28

what's the best prophylaxis treatment of unstable angina

Answer 28

aspirin and clopidogrel, STOP THAT CLOT