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Flashcards in ischemia3 Deck (37)
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1

what is the half life of nitroglycerin

1-3 minutes

2

what are the two active metabolites of nitroglycerin

glyceryl 1, 2-dinitrate
glyceryl 1, 3-dinitrate

3

what is the active metabolite of isosorbide dinitrate (ISDN)?

isosorbide-5-mononitrate (ISMN)

4

why is isosorbide 5-mononitrate preferred

4 hour half life

5

what nitrates are used for angina prevention

ISDN and ISMN
(not NTG)

6

how would you counsel a patient taking both NTG and sildinafil

48 hours before taking nitrates with Cialis
others 24 hours before taking nitrate

7

what dosing form is best for a patient with chest pain at night

transdermal NTG
(drug free in afternoon)

8

what is preferred ISMN or ISDN?
why (4 reasons)?

ISMN
longer half life
almost completely absorbed
less rebound angina
greater efficacy

9

what type of Ca channel is in vascular smooth muscle?
what is it's rate like?

voltage gated L-type Ca channels
slow rate

10

what is calcium entering a vascular smooth muscle's effect on MLCK

phosphorylation

11

what are the 3 main mechanisms of contraction of vascular tissue?
which is the main one CCB's inhibit?

1. voltage sensitive Ca channels open in response to depolarization
2. agonist induced release of calcium from SR
3. receptor mediated entry of calcium
#1=CCBs

12

what has an inhibitory effect in cardiac cells

troponin

13

what stops troponin's effect in cardiac cells

calcium binding (stops inhibition)

14

what effect do CCBs have on cardiac cells

negative inotropic effect

15

the negative ionotropic effect of dihydropyridines is caused by what?

peripheral dilation leading to baroreceptor reflex

16

what is CCB's effect on force of contration

decrease it

17

what is another term for inotropic effect on the heart

force of contraction

18

dihyropyridines peripheral dilation causes an increase in what?
what can this effect overcome?

increase SNS tone

can overcome negative inotropic effects on heart (why non-dihydro are better for myocardial ischemia)

19

what is significantly effected by nondihydropyridines

SA and AV nodes

20

what rate is not changed from dihydropyridines

does not change rate of recovery from Ca inhibition

21

what decreases rate of recovery from inhibition in cardiac cells

nondihydropyridines

22

what CCBs show use/ frequency dependance

nondihydropyridines

23

list the two nondihydropyridines

verapamil
diltiazem

24

all CCB's have what effect

vasodilation

25

arrange these drugs in order of ability to increase blood supply (coronary blood flow):
diltiazem, verapamil, dihydropyridines

dihydropyridines> verapamil > Diltiazem

26

what CCBs increase coronary blood flow the most

dihydropyridines

27

what are dihydropyridines effects on BP? what does this lead to?

decrease BP leading to:sympathetic reflexes
SNS reflexes cause increased HR and FOC

28

what CCBs have most potent inotropic effects

verapamil

29

CCB's have little effect on what related to blood flow

venous tone (so A > V)

30

what are some adverse effects of CCBs

1. edema
2. GERD
3. Urine retention
4. Rash
5. increased LFT's