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Flashcards in ischemia5 Deck (28)
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1
Q

what are the cardiac effects of beta blockers

A

decrease oxygen demand

decreasing HR, FOC, and BP

2
Q

what is the resting HR goal?

A

50 bpm

3
Q

what are the drugs of choice in exercise induced angina

A

beta blockers

4
Q

bb effect on heart rate can lead to what adverse effect

A

decrease in perfusion

5
Q

some studies showed beta blockers are better than CCB’s with improvement to what

A

symptomactic improvement

6
Q

why should BB’s not be used with nonDHPs

A

both work at SA and AV nodes

7
Q

what are two common adverse cardiac effects with beta blockers?
how is this avoided?

A
  1. increased end-diastolic volume (increases oxygen demand)
  2. increased ejection time (increases oxygen demand)
    avoided by concomitant use with nitrates
8
Q

increased end diastolic volume refers to what

A

more blood in the heart, increasing oxygen demand

9
Q

what are some contraindications with beta blockers

A
  1. bradycardia
  2. asthma
  3. AV block
  4. unstable left ventricular failure
  5. raynauds syndrome
10
Q

why can beta blockers impair exercise tolerance?

A

decrease sympathetic response to exercise; no increase in HR cutting back time someone can exercise

11
Q

what are some adverse effects noted with BB’s

A
  1. fatigue
  2. erectile dysfunction
  3. hypoglycemia
  4. impaired exercise tolerance
12
Q

why is hypoglycemia common with BB’s

A

masks the tremors associated with low blood sugar

13
Q

what is the only symptom of hypoglycemia when taking BBs

A

sweating

14
Q

what are two types of drugs that can be used for variant angina

A

nitrates and Ca channel blockers

15
Q

what is a second line agent for chronic stable angina

A

ranolazine (Ranexa)

16
Q

when is ranolazine used

A

in pt’s who experience continued angina despite max medical management and revascularization

17
Q

ranolazine has cardiac effects how?

what is not effected

A

it decreases oxygen demand

no effect on oxygen supply, HR and BP

18
Q

what are some adverse effects are associated with ranolazine

A
  1. dizziness
  2. constipation
  3. QT prolongation (K levels off)
19
Q

what should be monitored when on ranolazine

A

ECG and K levels

20
Q

what drug interactions are important to note with ranolazine

A

CYP3A4 inhibitors (verapamil and diltiazem)
digoxin
Simvastatin
Digoxin

21
Q

what is the max dose of ranolazine if taking verapamil or diltiazem

A

500 mg BID

22
Q

what is the max dose of simvastatin given in combo with ranolazine

A

20mg per day

23
Q

arterial relaxation results in:

a. increased afterload
b. decreased afterload
c. increased preload
d. decreased preload

A

b. decreased afterload

24
Q

which type of ischemic heart diseased is characterized by plaque rupture but normal tropronin levels?

a. stable angina
b. unstable angina
c. NSTEMI
d. STEMI

A

b. unstable angina

25
Q

list 3 acute coronary syndromes

A
  1. unstable angina
  2. STEMI
  3. NSTEMI
26
Q

what is a common adverse effect of sublingual nitroglycerin?

a. bradycardia
b. headache
c. hypertension
d. impotence

A

b. headache

27
Q

which would cause the greatest increase in oxygen supply to the heart?

a. amlodipine
b. diltiazem
c. verapamil

A

a. amlodipine

28
Q

how does ranolazine work in myocardial ischemia

a. decrease HR
b. decrease BP
c. Na channel blocker
d. Ca channel blocker

A

c. Na channel blocker