Pharmacology

Card Set Information

Author:
GK
ID:
99753
Filename:
Pharmacology
Updated:
2011-09-04 20:08:44
Tags:
ANTI ANGINALS
Folders:

Description:
ANTI-ANGINALS
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user GK on FreezingBlue Flashcards. What would you like to do?


  1. What are the 4 Nitrate drugs?
    a. They mimic the actions of endogenous NO and lead to vascular smooth muscle to cause relaxation and serve as endothelial independent vasodilators. More of an effect on veins than arteries.

    b. Contraindications: Should NOT be taken alongside Sildenafil. They both increase cGMP, which can lead to hypotension and impaired cardiac perfusion.

    c. Isosorbide Dinitrate

    d. Isosorbide Mononitrate

    e. Nitroglycerin

    f. Sodium Nitroprusside
  2. Isosorbide dinitrate, Isosorbidemononitrate
    a. Nitrates used for variant, stable and unstable angina.

    b. Have a longer half-life than nitroglycerin and are more useful in the long-term management and prophylaxis of angina.

    c. Isosorbide mononitrate has nearly 100% bioavailability making it unusual since the bioavailability of the other nitrates is low due to high first pass metabolism.
  3. Sodium nitroprusside
    a. Nitrate used for angina.

    b. Has a rapid onset of action. Only available as IV preparation due to short half-life, continuous infusion is required.

    c. Very useful in ICU and emergency situation.

    d. Adverse: Cyanide toxicity is rare but can occur as the parent compound releases both NO and cyanide. Can be treated with sodium thiosulfate infusion, which converts cyanide ions to inactive thiocyanate.
  4. Nitroglyceride
    a. Nitrate used for angina.

    • b. Rapid onset of action (2-5 min), when taken
    • sublingually, but its effects only last 30 min.
  5. Verapamil (diphenalkylamine)
    a. Calcium Channel Blocker (CCB). Used to treat HTN, angina and arrhythmias. Can be used to treat chronic stable, unstable, and Prinzmetal’s (variant) angina.

    b. They reduce Ca2+ entry into the cells so vascular smooth muscle relaxes (vasodilation), decreases myocardial force generation and decreased HR. They lower BP by decreasing peripheral vascular resistance.

    c. Has a greater negative inotropic action than other CCBs, but is a weaker vasodilator. It is able to reduce oxygen demand by decreasing HR and contractility and is able to relieve the symptoms of chronic stable, unstable, and variant angina.

    d. Adverse: Constipation in 7% of patients.
  6. Amlodipine, Felodipine (dihydropyridines)
    a. Calcium Channel Blocker (CCB). Used to treat HTN, angina and arrhythmias. Can be used to treat chronic stable, unstable, and Prinzmetal’s (variant) angina.

    b. They reduce Ca2+ entry into the cells so vascular smooth muscle relaxes (vasodilation), decreases myocardial force generation and decreased HR. They lower BP by decreasing peripheral vascular resistance.

    c. Anti-anginal effects of CCBs are derived both from their vasodilator and cardiodepressant actions. Vasodilation = increase in O2 supply.

    d. Dihydropyridines are more selective for vascular smooth muscle and have less effect on cardiac muscle than verapamil and diltiazem.

    e. Able to relieve symptoms of variant angina. Reduced reflex responses.

    f. Contraindicated in patients with bradycardia, conduction defects, heart failure.
  7. Diltiazem (benzothiazepine)
    a. Calcium Channel Blocker (CCB). Used to treat HTN, angina and arrhythmias. Can be used to treat chronic stable, unstable, and Prinzmetal’s (variant) angina.

    b. They reduce Ca2+ entry into the cells so vascular smooth muscle relaxes (vasodilation), decreases myocardial force generation and decreased HR. They lower BP by decreasing peripheral vascular resistance.

    • c. Anti-anginal effects of CCBs are derived both
    • from their vasodilator and cardiodepressant actions. Vasodilation = increase in O2 supply.

    d. Diltiazem is an intermediate between verapamil and the dihydrophyridines in its selectivity for vascular calcium channels. It’s able to relieve coronary vasospasm by dilating coronary arteries and is particularly useful in relieving the symptoms of variant angina.
  8. What are the 4 Calcium Channel Blockers used inangina?
    a. Amlodipine

    b. Diltiazem

    c. Felodipine

    d. Verapamil
  9. Propranolol, Metoprolol, Atenolol
    a. Beta adrenoceptor antagonits (beta-blockers).

    b. Used to treat HTN, angina, MI, arrhythmias and HF.

    c. Recommended in all patients with stable angina who have ACS or who have left ventricular dysfunction.

    d. Beta-blockers decrease myocardial contractility, HR and CO (blocking beta-1 receptors) and reduce renin secretion thus decreasing circulating angiotensin II levels. They reduce workload on heart and O2 demand.

    e. Propranolol – non-selective beta blocker

    f. Metoprolol and Atenolol – cardioselective beta-blockers (beta 1). Less likely to cause bronchospasm and vasoconstriction in patients with asthma, COPD and diabetes.
  10. Ranolazine
    a. Na+ channel blocker used for angina. Alternative option for patients with chronic angina that have failed all other therapies.

    b. MOA: Blocks the late inward Na+ currents in cardiomyocytes, which prevents Ca2+ overload leading to improved coronary blood flow. No significant effects on HR or arterial pressure.

    c. Metabolized by CYP3A4.

    d. Adverse: QT prolongation – main concern with this drug.

What would you like to do?

Home > Flashcards > Print Preview