Stuff that cause hyperpolarization.
Stuff that causes depolarisation.
What is angina pectoris?
Substernal pain like a tight band across the chest which comes upon exertion. Left arm, shoulder, shortness of breath, alleviated by rest.
Glyceride Tri Nitrite.
Causes of ischemia?
Obstruction of blood flow, Spasm of coronary arteries.
What cause angina?
Not enough oxygen supply creating accumilation of metabolites which causes pain.
Determinants of oxygen demand by heart tissue.
Wall stress, Heart rate, Contractility.
Types of angina.
Stable, unstable and variant.
When does stable angina occur?
Describe unstable angina.
More atherosclerosis than stable, it is UNPREDICTABLE, may occur at rest and pay main last longer.
Which form of angina is worse?
Risk factors for angina pectoris?
Hypertension, hyperlipidepia, smoking, diabetes, Anaemia, Thyrotoxicosis.
How drugs resolve angina?
Increase the supply or decrease the demand for oxygen.
Types of drugs used to treat angina?
Calcium channel blockers, beta blockers and nitrates.
How do nitrates work?
Venous dilatation and Arterial dilatation, Reduce preload and afterload of the heart. Decrease pressure in both arteries and veins.
Storage of GTN.
Drug is volatile and so should be stored in closed, non-plastic containers.
Peripheral edema with...
Beta blocker are not advocated for variant angina because?
It will block beta receptors while alpha is not affected, resulting in vasoconstriction resulting in more spasm.
Angiotensin receptor blocker.
An example of a PDE?
Viagra, blocks phosphodiesterase enzyme.
Atrial Natriuetic Peptide.
Through what mechanisms is depolarisation/ vasoconstriciton acheived?
Noradrenaline, ANG, Calcium and Sodium influx.
Through what mechanisms is vasodilation achieved?
Efflux of K, Beta agonists and Prostaglandins, ANP, NO.
Beta agonists and Prostaglandins.
ANP and NO.
Potassium channel activators, Nitric Oxide Donors, PDE inhibitors, Hydralazine, Calcium channel blockers, ACE inhibitors, alpha 1 blockers.viagra, blocks phosphodiesterase enzyme.
Calcium channel blockers.
Block L-type calcium channels.
Potassium channel activators.
KATP channel activation.
Nitric Oxide donors.
Increase Guanyl cyclase activity which inhibits vasoconstriction.
Decrease cAMP and cGMP breakdown.
Angiotensin Receptor Blockers.
Sympatholytics, ACE inhibitors/
Factors related to the stress affecting the cardiac wall?
Intraventricular pressure, Ventricular volume and thickness.
Variant angina pectoris.
Reversible coronary vasospasm.
CAN OCCUR AT REST.
Precipitating factors for angina?
After a large meal.
Glyceryl trinitrate, Isosorbide Mono and Di nitrate.
Calcium Channel Blockers.
Amlodipine, nifedipine, Verapamil, Diltiazem.
Propanolol, atenolol, metaprolol.
How do nitrates work?
Release Nitric Oxide which increases cGMP.
How do nitrates help in cardiac ischemia?
Produce coronary dilatation in collateral which increases distribution to ischemic areas,
Describe the reflex brought about by a loss in blood pressure?
Increase in heart rate and increase in O2 demand. Nitrates will increase heart rate.
Glyceryl trinitate is broken down by removing one nitrate molecule in three steps.
The speed of these three steps are progressively slower.
It forms an inactive metabolite which is conjugated with Glucorinide and then excreted.
Nitrates method of administration.
Adverse effects of Nitrates.
Hypotension and reflex tachycardia,
Pulsating headache and Flushing.
How to avoid Nitrate tolerance?
Give the drug in 8 hour intervals.
Calcium channel blockers and their effects.
How do calcium channel blockers work to reduce angina?
Vasodilation, Reduces venous return and AV conduction.
Reduces coronary vasospasm (important for Variant Angina).
Less work for the heart muscle.
Characteristics of calcium channel blockers.
Indications for Calcim channel blockers.
Migarine prophylaxis and Raynaud's disease.
Adverse effects of calcium channel blockers?
Cardiac depression (Verapamil and Ditltiazem)
Flushig, headache and diziness,
Contraindications for Calcium channel blockers?
Heart failure and with Beta blockers.
Types of beta blockers for angina pectoris?
Non selective (B1 and B2 - propanalol)
Selective (B1 - antenalol, metoprolol).
How do beta blockers work in making angina pectoris better?
Reduce BP by slowing down cardaic force and rate,
Reduce Oxygen demand.
Indications for beta blockers?
Stable heart failure (carvedilol),
Adverse effects of beta-blockers?
Respiratory - bronchoconstriction,
CVS - Bradycardia and decreased force of contraction, angina on withdrawal,
CNS - sedation, depression, sleep disturbances, nighttmares,
In diabetics - Exacerbation of hypoglycaemia but masking of symptoms.
Ticlopidine, Clopidrogel, Aspirin.
Treat an acute anginal attack.
GTN, Isosorbide dinitrate.
Drugs for angina prophylaxis.
Calcium channel blockers,
Drugs for Unstable Angina.
Nitrates, Aspirin/other antiplatelet.
Vasodialators used in the treatment of heart failure?
ACE inhibitors, Nitrates, Hyrozaline and Alpha receptor blockers.