Vasodilators and Anti-anginal medications Flashcards Preview

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Flashcards in Vasodilators and Anti-anginal medications Deck (43):
1

Factors that affect myocardial oxygen demand

contractility, heart rate, ventricular wall tension (preload)

2

Factors that affect myocardial oxygen supply

coronary blood flow, diastolic BP, coronary artery resistance, regional blood flow distribution, faster heart rate

3

Dilating veins causes

decreased venous return, decreased ventricular end-diastolic pressure, reduced cardiac workload

4

Decreasing peripheral arteriolar resistance causes

decreased vasodilation, reduced oxygen demand, reduced myocardial work

5

muscle contraction occurs when

voltage dependent Ca channels open and Ca comes into the cell

6

decreased intracellular Ca leads to

vasodilation

7

what causes inhibition of Ca release

alpha blockers, organic nitrates, nitrites, angiotensin receptor blockers

8

what inhibits breakdown of cyclic GMP

phosphodiesterase inhibitors

9

NO binds and activates what and has what effect

cytosolic guanylate cyclase which converts GTP to cGMP

10

the overall effect of cGMP is to cause what

smooth muscle relaxation by decreasing intracellular calcium levels

11

Nitroglycerine MOA

forms nitric oxide which activates guanylate cyclase, which increase cGMP and causes vascular smooth muscle relaxation

12

nitroglycerine affect on demand

reduces myocardial demand by decreasing preload because cause venous vasodilation

13

Nitroglycerine ADR

Headache, also hypotension, bradycardia, dizziness, syncope, reflex tachycardia

14

Nitroglycerine and tolerance

tolerance can develop withing 24-48 hours of continuous administration, need a nitrate free period for 10-12 hours

15

Some effects of nitrates

decrease ventricular volume, decrease arterial pressure, decrease ejection time, vasodilation of coronary arteries, increase blood flow to collateral arteries

16

Ways to administer nitroglcerine

oral, intravenous, ointment, transdermal, sublingual, spray

17

Proper use of nitroglycerine sublingual tablet

Sit down, take 1 tablet, wait five minutes, if no relief call 911, take second dose, if no relief take third dose; pt should not drive self to hospital

18

Isosorbide dinitrate (Isordil)

a long acting nitrate with same results as giving nitroglycerine itself, increases availability of NO

19

Isosorbide dinitrate (Isordil) use

acute andina only if pt did not respond to SL nitro, used less common but inexpensive

20

Isosorbide mononitrate (Imdur)

a long acting nitrate that ultimately results in release of nitric oxide

21

isosorbide mononitrate (Imdur) use

not used for acute angina, but chronically for pain prevention, USED REGULARLY

22

Isosorbide mononitrate (imdur) should not be used in patients currently taking

phosphodiesterase inhibitors (viagra, Levitra, cialis)

23

Nitroprusside (Nipride) MOA

peripheral vasodilation of arteries and veins*, very quick acting

24

Most common use for nitroprusside

hypertensive crisis

25

Milrinone (primacor) MOA

a selective phosphodiesterase inhibito in cardiac and vascular tissue, prevent cGMP breakdown, results in vasodilation and has inotropic effect

26

2 forms of milinone

short acting (2 hours) and quick acting (5-15 mins)

27

Main use of milrinone (primacor)

heart failure

28

Nesiritide (Natrecor) MOA and use

binds guanylate cyclase and increases cGMP, used for acute decompensated heart failure

29

3 important facts of nesiritide (Natrecor)

only available IV for short term continuous infusion, and can cause renal failure, very inexpensive

30

Sildenafil (viagra)

Phosphodiesterase inhibitor, 60 min onset last 2-4 hours, take with high fat meal

31

Sildenafil (Revatio)

phosphodiesterase inhibitor, used for pulmonary arterial hypertension

32

ADR of sildenafil

HA, hypotension, priapism, flushing, visual disturbances

33

Tadalafil (Cialis)

PDE inhibitor, erectile dysfunction, niche lasts 36 hours, expensive

34

Tadalafil (adcirca)

PDE inhibitor, BPH, expensive

35

Vardenafil (Levitra)

PDE inhibitor, erectile dysfunction, niche faster onset?

36

Avanafil (Stendra)

PDE inhibitor, me too, 30 min onset?

37

Minoxidil (Loniten, Rogaine) MOA

K channel agonist inhibits voltage gate Ca channel

38

Minoxidil (loniten, rogaine) use

antihypertensive but stimulates hair growth

39

Hydralazine (Apresoline) MOA

potent dilator of arteries, short acting, give 3-4 times a day

40

Hydralazine (Apresoline) uses

Hypertension, not fist line, acute hypertension, IV rapid response (5-10 min), pre-eclamsia, inexpensive

41

Ranolazine (Ranexa) MOA

Inhibits Na channel during cardiac repolarization, reduces Ca concentration

42

Ranolazine (Ranexa) use and benefit

prevent angina, doe not cause tachycardia, or hypotension, minimal ADR and well tolerated drug

43

contraindications of Ranolazinf(Ranexa)

hepatic impairment and CYP3A4 inhibitors, expensive