Flashcards in Quiz 3 Study Guide: Cardiovascular Therapeutics Deck (49):
By what 2 mechanisms is angina treated?
1. Vasodilation (Increase flow)
-Nitrates and Nitrites
2. Decrease O2 consumption
- B Blockers; Ca++ channel blockers
How do Nitrates/Nitrites work to treat angina?
Metabolize Nitric oxide to increase cGMP therefore relaxing smooth muscle and dilating cardiac vessels
What are some examples of Nitrates/Nitrites?
Characteristics of Nitroglycerine...
-Volatile (Sealed Glass bottle)
Long-lasting patches (8hrs)
Characteristics of Amyl-Nitrate
-Crushed ampule and fumes inhaled
Side effects of Nitrates/Nitrites
Tachycardia (reflex to dilation)
Throbbing headache (Vasodilation)
Tolerance develops rapidly
How do Ca++ Channel Blockers work to treat angina?
Blocks contraction of smooth and cardiac muscle to reduce O2 demand.
What are Ca++ Channel Blockers used for?
Prophylaxis of angina (4-8 hour duration)
"take in the morning to prevent angina during the day"
What are examples of Ca++ Channel Blockers?
*also used as hypertensives
What Toxic side effects can be present with Ca++ Channel Blockers?
-Cardiac depression and bradycardia (Heart Failure)
-Flushing and dizziness.
How do B Blockers (B1) work to treat angina?
Decreases Blood output by decreasing the HR, causing BP and contractility to decrease.
*Not a vasodilator
What are some examples of B blockers used to treat angina?
Propanolol (Nonselective - Pulmonary problems)
atemolol (B1 selective - less lung problems)
What Toxic side effects can be present with B Blockers?
-acute heart failure
What are non-drug lipid and cholesterol-lowering treatments?
-15-20% daily intake of fat calories
-avoid red meats
What do Statins do?
They are competitive inhibitors of HMG-COA Reductase.
*they reduce the synthesis of cholesterol (LDL) and reduce coronary events.
What are some examples of Statins?
What are side effects of Statin Toxicity?
Weakness in skeletal muscles.
What do Fibrates do?
Increases lipolysis in liver and muscles
*reduces VLDL, modest effect on LDL, and moderate increase in HDL. Reduces Triglycerides.
What is an example of a fibrate?
*side effect is GI symptoms
What does Niacin (nicotinic acid) do?
Decreases triglyceride and LDL
What is a side effect of Niacin?
Fairly pronounced Mild Flushing.
What do Bile acid-binding agents do?
Reduces reabsorption of bile acids and metabolite.
Toxicity: Constipation and Bloating
What is and example of a Bile acid-binding agent?
What do inhibitors of intestinal sterol absorption do?
Inhibits intestinal absorption of cholesterol and reduces LDL.
What is an example of and inhibitor of intestinal sterol absorption drugs?
What is the objective of treatment for patients with heart failure?
Reduce symptoms and slow progression
What are the 6 types of drugs that treat heart failure?
Positive Ionotropic Drugs
B1 adrenoceptor agonists
B adrenoceptor blockers
*Na+ restriction as dietary non-drug treatment
What do Positive Ionotropic drugs do?
Increases intracellular Ca++ and Cardiac contractility therefore increasing blood ejection.
What are examples of Positive Ionotropic Drugs?
Milrinone -this is really a Bipyridine drug
What are side effects of Positive Ionotropic Drugs?
Premature depolarization (arrhythmias)
Affects all excitable tissues
What is an example of a B1-adenoceptor agonist?
*can cause arrythmias
What do diuretics do?
-Reduce salt and H2O retention and edema
-Reduce venous pressure and ventricular preload
What is an example of a diuretic?
What do ACE inhibitors do?
Reduce peripheral resistance by reducing salt and water
What is an example of an ACE inhibitor?
What does a Vasodilator do?
Relax smooth muscle
What is an example of a Vasodilator?
What does a B adrenoceptor blocker do?
Reduce heart rate and block the Sympathetic Nervous System
What is and example of a B adrenoceptor blocker?
What are characteristics of Cardiac Arrhythmias?
-80% with history of Myocardial Infarct
-Requires treatment if there is significant reduction in cardiac output
-Treatments themselves can cause arrhythmias
What types of drugs treat Cardiac Arrhythmias?
Na+ channel blockers
B adrenergic blockers
Ca++ channel blockers
What do Na+ channel blockers do to treat cardiac arrhythmias?
Slows action potential conduction
Effective for most A or V arrhythmias.
*can precipitate new arrhythmias.
What is an example of a Na+ channel blockers used to treat cardiac arrhythmias?
Which drug is the 1st choice for ventricular arrhythmias.
What are Prolong refractory drugs used for when treating cardiac arrhythmias?
A fib. or V. arrhythmias
What is an example of a Prolong Refractory Drug?
What is and example of a B blocker used for arrhythmias?
What do Ca++ channel blockers do to treat cardiac arrhythmias?
Prolong refractory time