Ischemic HD Phys/Pharm Flashcards Preview

Cardiovascular > Ischemic HD Phys/Pharm > Flashcards

Flashcards in Ischemic HD Phys/Pharm Deck (31):
1

non selective Beta blockers

propanolol, timolol

1

therapeutic effect Beta blockers

decrease contractility and heart rate > decrease O2 demand

slowing HR can improve ischemic area flow

2

oral availability nitrates

nitroglycerin - high first pass

isosorbide dinitrate - 25%

2

adverse effects and contraindications beta blockers

Contra: obstructed airway

acute decompensated heart failrue

marked bradycardia / heart block 

caution insulin treated diabetics

adverse: fatigue, sexual dysfxn

3

pharmacokinetics Nitrates

nitroglycerin significant first pass

isosorbide dinitrate metabolized to mono

mononitrate not metabolized

 

4

at __% obstruction, cannot reach maximal flow

at ___% obstruction, distal perfusion pressure cannot maintain normal resting flow

70%

90%

4

B1 selective Beta blockers

metoprolol, atenolol

4

non-dihydropyridine Ca blockers

verapamil, diltizem

4

therapeutic effect nondihydropyridine Ca blockers (verapamil, dilitiazem)

decrease O demand by reducing contractility and HR

(less potent vasodilators than dihydropyridines nifedipine and amlodipine)

6

3 determinents of myocardial O2 demand

Wall stress

HR

contractility

7

electrocardiogram chronic stable angina during ischemia

ST segment depression and T wave inversion

(normalize quickly)

8

Therapeutic effect and mechanism Ranolazine

inhibit late sodium current in myocytes 

decreases anginal episodes and increases exercise capacity

10

normal endocardial/epicardial blood flow ratio

1

11

major area of nitrate impact

venous circulation

12

therapeutic effect dihydropyridine Ca channel blockers (nifedipine, amlodipine)

decrease O demand via vasodilation > decrease afterload > decrease wall stress

increase coronary O supply via vasodilation

13

adverse effects Ca blockers

headache flushing

decreased contractility

Bradycardia

edema (esp nifedipine, diltiazem)

constipation (especially verapamil)

14

Unstable angina and MI

plaque rupture > platelet aggregation adn thrombosis > unopposed vasoconstriction

15

silent ischemia

cardiac ischemia without discomfort or pain

17

therapeutic effects of nitrates (not mechanism)

increase venous capacitance (decreasse preload)

small reduction in systemic art pressure (pos reflex tachy+contractility)

Coronary dilator

18

specific indications dihydropyridine Ca blockers (nifedinpine, amlodipine)

relief of vasospasm

19

syndrome X

typical signs of angina with no evidence of atherosclerotic stenoses

20

increase in coronary O2 demand is met via

increases in coronary flow

21

flow is matched with coronary need via ___

autoregulation 

22

Q =

P/R

23

nitrates adverse effects

headache

hypotension

reflex tachy

flushing

24

wall stress

Pxr/2h

26

perfusion pressure dependent on ___ prssure

diastolic pressure

27

nitrate drugs

Nitroglycerin

isosorbide mono- and dinitrate

28

stable angina

lumen narrowed by plaque

inappropriate vascoconstriction

29

caution should be taken when combining ___ 

beta blocker and nondihydropyridine Ca blocker (cardiodepression)

30

dihydropyridine Ca channel blockers

Nifedipine, alodipine