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Cardiology 410 with Stiener at Albany College of Pharmacy

About this deck

By: Tim Sissel
Created: 2011-11-17
Size: 43 flashcards
Views: 3

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what is ischemic heart disease?

•Dabigatran (Pradaxa) –FDA approved for stroke prevention in atrial fibrillation •Used in other countries for DVT prophylaxis –Twice daily regimen –No monitoring –Quick onset –Short half life –Renal elimination (80%)

what is angina pectoris?

strangling in the chest”

Chest pain (tightness or pressure sensation)

americans with ihd and deaths from?

Affects 81,100,00 Americans

2400 deaths per day, 1 every 38 seconds

what causes ihd

Caused by atherosclerosis of epicardial vessels -> coronary artery disease

-in women, shortness of breath, fatigue, nausea

-myocardial infarction in men

is ihd increaing?

Incidence and mortality decreasing

-awareness of lifestyle choices on heart disease

-coronary artery surgery

12 year survival rate 0,1,2,3 vessle disease?

12 year survival rate: 0-, 1-, 2-, or 3-vessle disease

88%, 74%, 59% and 40%

Normal hearts Determinants of O2 demand

1.Heart Rate

2.Contractility

3.Heart wall tension/stress during systole

determinants of o2 supply?

Determinants of supply

1.Oxygen content (constant)

2.Coronary blood flow (dynamic)

-Perfusion pressure

-Coronary vascular resistance

the healthy heart extracts what % of o2 from blood?

The healthy heart extracts ≥75% of the oxygen supplied.

-to get more O2, need to increase blood flow

Ischemia develops due to:

1)Physical resistance

2)Vasospasm-damaged endothelium

what does artherosclerosis do to blood vessels?

Inhibits auto-regulation of coronary artery resistance, and maintenance of blood flow

what is a vasospasm?

Sympathetic nervous system stimulated to release vasodilators

-outweighs effect of aggregating platelets on constriction

artherosclerotic plaques do what in ihd?

Sympathetic nervous system stimulated to release vasodilators

-outweighs effect of aggregating platelets on constriction

ihd risk factors?

IHD Risk Factors:

Hypercholesterolemia

Diabetes mellitus

Hypertension

Cigarette smoking

Goals: of ihd therapy?

Decrease frequency of anginal attacks, prevent acute syndromes (MI), and prolong survival.

-address underlying causes/risk factors

preentative therapy of ihd?

drugs aimed at preventing atherosclerosis and thrombus formation.

palliative therapy of ihd?

decrease the severity and recurrence of ischemic episodes without eliminating the cause of the problem.

corrective therapy in ihd?

surgical interventions to restore circulation to ischemic areas.

Three main drug classes for Angina treatment:?

1.Nitrates

2.Calcium channel blockers

3.Beta-blockers

Function by lowering myocardial oxygen requirement?

decrease oxygen demand

-redistribute coronary flow

-reverse vasospasm

nitroglycerin info?

•Crosses mucosa well

• Highly metabolized in the liver

(T1/2 = 1-3 min)

(oral bioavailability < 20%)

• Indication: Angina crisis

(sublingual administration to avoid first-passage liver metabolism)

organic nitrate half life and shit?

T1/2 < 8 min

Low oral bioavailability

active metabolite t1/2 and bioavail?

Active metabolite

T1/2 = 3-6 h

100% oral bioavailability

mechanism of nitroglycerine?

increases nitric oxide conc.

what does this nitroc oxide up lead to?

up in coronary flow down in resistance

organic nitrates mech on heart?

down in preload

decreased heart size less wall stress

ADVERSe effects of organic nitrates?

•Orthostatic hypotension (like other venous dilators)

•

• Tachycardia & palpitations (due to sympathetic activation)

•

• Headache

how does viagra work?

down in bp up in erection baby!

how does verapamil work?

Indication: Prevention of angina recurrence inhibition of ca+

what are l type smooth muscle and cardiac muscle?

long duration, high threshold, large current

verap works on this dihydropyridines

how do ca+2 channel blockers work?

Oppose contraction in coronaries and other arteries; weak effect on veins. also on heart

therapuetic effect of ca+2 blockers?

Coronary arteries

Vasodilation

•

Heart

¯ contraction force

¯ heart rate

2 positive benefits of ca+ blockers?

¯ Heart rate not only reduces the heart’s workload, but also improves coronary blood flow.

side effects of verapamil?

hypotension, bradycardia, constipation

diltiazem side effects?

hypotension, bradycardia

nifedipine side effects?

hypotension

beta blocker antagonist absorbed? t1/2? indication?

Absorbed in the GI tract.

T1/2: 3.5-6 h

Indication: Prevention of angina recurrence, particularly angina associated with exercise.

therapuetic effects of beta blockers?

Coronary tone

No vasodilatory effect

•Heart

¯ contraction force

¯ heart rate

(improves coronary flow)

Wall stress = P × r / 2h

adverse effects of beta blockers?

Asystole and cardiac arrest

In patients with AV node dysfunction or patients taking other bradycardic medications (e.g., Ca2+ channel blockers).

Bronchospasm

In patients with reactive airway disease.

ranolazine therapeutic effects?

Coronary arteries

No effect

Heart

No Effect

Other

•Prevents/reverses mechanical dysfunction

•Normalizes LV repolarization

ranolazine mech?

Mechanism of Action

Reduces calcium overload in ischemic myocyte by inhibiting the Sodium Channel.

-Blocks late sodium current INa

-Reduces contractility

ranolazine adverse effects?

Prolongs the QT interval -> arrhythmia

Hepatic impairment

Inhibits CYP450 3A -> drug-drug interactions

About this deck

By: Tim Sissel
Created: 2011-11-17
Size: 43 flashcards
Views: 3

About StudyBlue

“I have used this website for three exams, and I see a huge difference in my test results.”
Naj