Vasodilators

Question 1

Targets

Answer 1

Exogenous NO

L-type calcium channel blockers

Question 2

Nitroglycerin/Isosorbide nitrate

Answer 2

Prodrug converted by ALDH-2 to NO
venous dilator, decrease preload venous pooling in the periphery
CBF increased to endocardium
No direct heat changes (no increase HR or contractility)

Question 3

Adverse of NO

Answer 3

Reflex tachycardia
Orthostatic hypotension
DO NOT combine with ED meds

Question 4

Alcohol effect on ALDH-2

contradictory

Answer 4

Inhibits ALDH-2 = prevent formation of NO

Alcohol is also a vasodilator

Question 5

Tolerance of NO

Answer 5

Due to inactivation of ALDH-2
cannot form as much NO from prodrug to vasodilate
Oral and transdermal (not in sublingual)
Cross-tolerance common
Avoid with eccentric dosing

Question 6

Calcium channel blockers subclasses

Answer 6

Dihydropyrimidines
Heart-rate lowering drugs
Action: block L-type channel (alpha-1a subunit)

Question 7

Dihydropyrimidines

Answer 7

Nifepime

Question 8

Heart-rate lowering calcium channel blockers

Answer 8

Verapamil

Dilitiazem

Question 9

Nifepime

Answer 9

Dihydropyrimidines
Selective VSM >>>> cardiac
MINIMAL cardiac effects
dilates arteries = reflex tachycardia, flushing
Not used as much

Question 10

Verapamil and Diltiazem

Answer 10

Selective VSM&raquo_space;> cardiac
AND work on heart!! = SA and AV Node
Dilitazem produces less cardiac depression

Question 11

Beta adrenergic receptor antagonists

Answer 11

Propanolol

Question 12

Propanolol

Answer 12

B-blocker
Decrease HR, contractility, and BP
CIELING - exercise-induced tachycardia, HR cannot increase past a certain point

Question 13

IMPORTANCE OF B-BLOCKERS

Answer 13

REDUCED MORTALITY

SURVIVAL BENEFIT

Question 14

Combinations

Answer 14

B-blocker + NTG
CCBs monotherapy (can be add ons)
NO B-blocker and HRL-CCBs (too much HR lowering)

Question 15

Sildenafil (viagra)

Answer 15

Selective inhibition of Phosphdiesterase-5 in VSM of corpora cavernosum
PROLONG cGMP to produce vasodilation
Need 1. sexual stimulation 2. PNS innervation intact

Question 16

Adverse of sildenafil

Answer 16

headache and flushing
*abnormal vision - PDE6 in eye
hearing loss
*Priapism (Rare)

Question 17

What is different between CCBs compared to NO?

Answer 17

dilation of arteries

Peripheral and coronary = decreases the afterload (less resistance to push blood into)

Question 18

Adverse effects of propanolol

Answer 18

Rebound MI after withdrawal
Bad for variant angina
Contraindicated w/ agents with intrinsic B1

Question 19

Why would a patient on B-blocker have issues with exercise and feel fatigued?

Answer 19

Cieling effect on HR