EXAM #2: CV PHARM VIII Flashcards Preview

Pharmacology > EXAM #2: CV PHARM VIII > Flashcards

Flashcards in EXAM #2: CV PHARM VIII Deck (22):
1

What is the physiologic cause of angina?

Release of BRADYKININ and ADENOSINE onto nociceptive afferents

2

What is angina?

Retrosternal chest pain radiating to the neck, jaw, or back

3

What is "stable" angina?

Short-duration anginal pain precipitated by:
- Exercise
- Cold weather
- Stress

4

What is "unstable" angina?

Longer-standing anginal (~20 min) pain
- Occurs at REST and dissipates with rest
- Crescendos

5

What are the hallmarks of AMI?

- Sudden onset
- Lasts longer than 30 min.
- Associated with dyspnea, weakness, nausea, and vomiting

6

What are the two general approaches to altering myocardial oxygen consumption to decrease angina?

1) Decrease myocardial oxygen demand
2) Increase myocardial supply

7

What classes of drugs decrease myocardial oxygen demand?

Beta-blockers
Ca++ blockers
Organic nitrates
Ca++ entry blockers

8

What are the classes of drugs that increase myocardial oxygen supply?

Vasodilators
Statins
Anti-thrombics

9

List the organic nitrates that are used for myocardial ischemia.

Nitroglycerin
Isosorbide Dinitrate
Isosorbide Mononitrate

10

What enzyme activates organic nitrates?

mitochondiral aldehyde reductase

11

What is the mechanism of action of the organic nitrates?

1) NO increases cGMP
2 cGMP activates cGK-1, which:
- Increased mitochondrial Ca++ uptake
- Decreases Ca++ influx
- Phosphorylates MLCK

12

What is the effect of MLCK phosphorylation?

Myosin Light Chain Kinase= MLCK
- Phoshorylation of MLCK inhibits its activity
- When phosphorylated, MLCK cannot activate
Myosin Light Chain, which would cause vasoconstriction

Thus, MLCK phosphorylation causes VASORELAXATION

13

What is nitrate tolerance? What are the clinical implications?

Sustained organic nitrate therapy reduces the efficacy of the drugs

*****Thus, in patients that need this therapy, a bridge with a different class drug for part of the day is recommended*****

14

Describe the half life to NTG.

Undergoes hepatic and intravascular metabolism v. quickly

****T1/2 is 1-4 minutes

15

What is the advantage of Isosorbide Dinitrate?

Available in a sustained release form that allowing for dosing once daily

-->Avoids nitrate tolerance

16

What are the unique characteristics of Isosorbide Mononitrate?

1) Does not undergo first-pass hepatic metabolism
2) Available in a sustained release form that allowing for dosing once daily

17

What are the pharmacodynamic effects of the organic nitrates?

Vasodilation of veins DECREASES preload

-->decreases workload of the heart; does NOT dilate the coronary vasculature

18

What is coronary steal?

Altered coronary blood blow leads to a reduction in coronary blood flow

19

What are the indications for sublingual nitrates?

1) Acute angina
2) Prophylactic therapy to prevent angina
3) CHF
4) MI

20

What are the indications for long-acting nitrates?

- Used in patients with angia to decrease episode frequency and increase exercise duration

21

What combination therapy is recommended for African Americans with CHF from systolic dysfunction?

ISDN + Hydralazine

22

What are the side effects of organic nitrates for myocardial ischemia?

- Headache
- Hypotension

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