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Antianginal Drugs Fr
FARM TEST 4
| Question | Answer |
|---|---|
| What is the principle symptom of ischemic heart disease? | Angina pectoris |
| Where is angina pectoris pain felt? | Middle of the chest behind the sternum. |
| What are the 3 major categories of angina pectoris? | Stable, unstable, vasospastic |
| Describe Stable angina pectoris. | Predictable in response to exertion, stress. |
| Describe Unstabla angina pectoris. | Increase risk of MI/death, need to use antiplatelet therapy |
| Describe Vasospastic angina. | Caused by coronary artery spasm, can produce pain at anytime even while asleep, little evidence of coronary flow impairment |
| Name factors that affect myocardial oxygen demand. | Contractility, heart rate, ventricular wall tension, preload, afterload |
| Name three classes of ANTIANGINAL DRUGS. | Organic nitrates, B-Adrenergic receptor antagonists, Calcium channel blocking drugs |
| How do Oragnic nitrates work? | They decrease preload and afterload resulting in decreased myocardial work and decreased oxygen demand, increase heart rate/contractility, decrease wall tension |
| Do organic nitrates DIRECTLY alter INOTROPIC or CHRONOTROPIC state of the hear? | No |
| What effects do Organic Nitrates have on Coronary blood flow? | They dilate large coronary arteries and collateral vessels to increase oxygen delivery. |
| What is the mechanism of pain relief in angina? | Organic nitrate drugs decrease myocardial work and decrease oxygen demand, some improvement of heart perfusion. |
| Name an Organic Nitrate. | Nitroglycerin |
| What is the oral bioavailability of organic nitrates? | Low due to the first-pass metabolism in the liver. |
| How much of Oral Isosorbide is absorbed? | It is completely absorbed. |
| What route of organic nitrates are used to provide prophylaxis against angina? | Oral and transdermal |
| Name Adverse Effects related to Organic Nitrates. | Vasodilation, hypotension, orthostatic hypotension, reflex tachycardia |
| What type of angina are Organic Nitrates used for? | Stable and Vasospastic Angina |
| How do B-Adrenergic receptor antagonists work? | Decrease Afterload, heart rate, contractility, wall tension |
| What do B-adrenergic receptors do to the heart muscle? | They increase its contractility, heart rate, and secret renin in kidney. |
| What are the 3 major determinants of myocardial oxygen demand? | Heart rate, contractility, systolic wall tension when reduced. |
| Name two B-Adrenergic receptor antagonists. | Propranolol, metoprolol |
| Which B-Adrenergic receptor antagonist will you use for B1 B2 receptors? | Propranolol |
| What type of receptors does Metoprolol work on? | Only B1 |
| What are adverse effects of B-Adrenergic receptor antagonists? | Wheezing, bronchoconstriction, bradycardia. |
| What can occur with an abrupt withdrawal of B blockers? | They can worsen angina. |
| Are B-Adrenergic receptor antagonists useful for VASOSPASTIC angina? | No, they are most useful in pts w/ frequent and unpredictable angina attacks. |
| Name two CCB drugs. | Verapamil, Nifedipine |
| Out of Verapamil and Nifedipine, which one has a direct effect on the heart? | Verapamil |
| What is the major use of CCB? | Angina Pectoris, Hypertension, Cardiac Arrhythmias |
| What are the effects of Verapamil on the heart? | Decrease afterload, heart rate, contractility, wall tension |
| What are the effects of Nifedipine on the heart? | Decreased afterload, wall tension, Increased heart rate |
| Which CCB affects the SA node and AV conduction slowing down the heart rate? | Verapamil |
| Which CCB causes reflex tachycardia? | Nifedipine |
| Describe the Chronic Angina Pectoris treatment algorithm. | Sublingual Nitro, Beta Blocker, CCB, Long acting nitrate, Revascularization |
| Name five diuretics. | Furosemide, Hydrochlorothiazide, Spironolactone, Triamterene, Mannitol |
| What are some used of Diuretics? | Treat Hypertension, Mobilize Edema Fluid, Prevent Renal Fluid |
| How do most Diuretics work? | By increasing Na excretion and diuresis |
| Where does filtration occur in the kidney? | The glomerulus |
| Where does resorption occur in the kidney? | Tubular epithelium |
| Where does Tubular Secretion occur in the body? | Distal Nephron |
| What part of the Kidney does Mannitol work on? | Proximal Convoluted Tubule |
| What part of the Kidney does Furosemide work on? | Ascending limb of Loop of Henle |
| What part of the Kidney do Thiazides work on? | Early Distal Convoluted Tubule |
| What part of the Kidney do Spironolactone & Triamterene work on? | Late Distal Convolute Tubule and Collecting Duct (distal nephron) |
| What is the fxn of the Proximal Convoluted tubule? | Resorption of Na, Cl, K, Bicarbonate, glucose and amino acids. |
| What is the fxn of the Loop of Henle? | Decrease urine volume, concentrate urine |
| What are the Main Classes of Diuretics? | Loop (high ceiling) Diuretics, Thiazide diuretics, K Sparing diuretics, Na Channel blockers, Osmotic Diuretics |
| What is blocked by Loop Diuretics? | Na-K-2Cl co transporter |
| What are the therapeutic uses of Loop diuretics like Furosemide? | When rapid and massive fluid removal is needed |
| What are the PO and IV action times for Furosemide? | PO 60 minutes and lasts 8 hrs, IV w/in 5 minutes and last for 2 hours |
| What are the adverse affects of Furosemide? | Hyponatremia, hypochloremia, dehydration, hypotension, HYPOKALEMIA, ototoxicity, hyperuricemia. |
| Name some drug-drug interactions for Furosemide. | Digoxin, Otoxoic drugs, increase lithium toxicity. |
| Name a Thiazide Diuretic. | Hydrochlorothiazide |
| Where do Thiazdie Diuretics work at? | Distal Convoluted Tubule |
| What is the MOA of Hydrochlorothiazide? | Blocks the resportion of Na and Cl cotransporter |
| When doe Thiazides not work well? | When renal blood flow and glomerular filtration rates are low. |
| What are the pharmacokinetics of Hydrochlorothiazide? | PO peak at 4-6 hrs and lasts 12 hrs DONT TAKE AT BEDTIME. |
| What are the Therapeutic uses of Hydrochlorothiazide? | Primary Hypertension, Diabetes Insipidus, Decrease kidney stones |
| What are adverse affects of Hydrochlorothiazide? | K losing diuretic, Increase plasma glucose, lipid levels, SHOULD NOT BE USED DURING PREGNANCY, NO OTOTOXICITY. |
| Name DRUG-DRUG for Hydrochlorothiazide. | Increase digoxin/lithium toxicity, COMBINED W/ ANTIHYPERTENSIVES |
| What class of Diuretics decrease K excretion but only produce a modest increase in urine volume? | Potassium Sparing Diuretics |
| Name a Potassium Sparing diuretic. | Spironolactone |
| Where do Potassium Sparing diuretics work? | At the collecting duct. |
| What is the MOA of Potassium Sparing Diuretics? | Blocks the ability of Aldosterone, leading to increase Na excretion and decrease K excretion. |
| What are the adverse effects of Potassium Sparing Diuretics? | Hyperkalemia, Gynecomastia, irregular Menses, Impotence, Hirsutism, Deepening voice |
| What type of drugs should not be combined with Potassium Sparing Diuretics? | ACE inhibitors |
| Name a Na channel blocker? | Triamterene |
| What is the MOA of Na Channel blockers? | Blocks Na channel. |
| What are the pharmacokinetics of Triamterene? | More rapid effects than Spironolactone |
| What are the therapeutic uses of Triamterene? | Treat hypertension/edema. |
| What are the Adverse Effects of Triamterene? | Hyperkalemia, N,V, leg cramps, dizziness, blood dyscrasias. |
| Name an Osmotic Diuretic. | Mannitol |
| What is the MOA of Mannitol? | It gets rid of Intracellular water as it pulls water out of cells. |
| What are the pharmacokinetics of Mannitol? | IV effects in 30-60 minutes |
| What are the adverse effects of Mannitol? | HA, N, V, fluid/electrolytes imbalances occur, ECV is acutely increased = HF |
| What are the therapeutic uses of Mannitol? | Prophylaxis of Renal Failure, reduce intracranial pressure/intraocular pressure |
| What are the two types of hypertension? | Primary and Secondary |
| What is another name for Primary hypertension? | Essential Hypertension |
| Which hypertension has an identified primary cause and some people can be cured by treating the cause? | Secondary Hypertension |
| What are the systems that help regulate blood pressures? | Baroreceptor reflex, Renin-Angiotensis System (RAS), Renal Regulation of blood pressure |
| What is the purpose of Alpha 1 adrenergic receptors? | To cause vasoconstriction |
| What is the purpose of Alpha 2 adrenergic receptors? | Decrease sympathetic tone in brain/periphery |
| What is the purpose of Beta 1 adrenergic receptors? | Increase heart rate/contractility, stimulate renin |
| What is the purpose of Beta 2 adrenergic receptors? | Dilate skeletal musculature during flight or fight. |
| What does a decrease in arterial pressure do? | Decreases GFR which promotes retention of Na, Cl, and H2O increasing blood volume. |
| What does Angiotensin II control? | Blood pressure |
| What type of drugs are used to treat hypertension? | Diuretics |
| What is the most commonly used diuretic for hypertension used in monotherapy or combination? | Thiazides |
| How doe Thiazides work? | ↓ blood volume & arterial resistance |
| What are the adverse affects of Thiazides? | ↓K, dehydrations, hyperglycemia, hyperuricemia |
| Which diuretic drugs is reserved for pts requiring maximum diuresis and pts with low GFR? | Loop Diuretics (High Ceiling) |
| What are the adverse effects of Loop Diuretics? | ↓ K, dehydration, hyperglycemia, hyperuricemia, OTOTOXICITY |
| Which diuretics are the least effective but balance the K loss by thiazides or loop diuretics? | Potassium Sparing diuretics |
| What is the most significant adverse effect of Potassium Sparing Diuretics? | HyperKalemia |
| Can you use Potassium Sparing Diuretics with ACE inhibitors? Why or Why not? | No, because ACE inhibitors can cause hyperkalemia. |
| How do Sympatholytics fxn? | They suppress the influence of the sympathetic nervous system on the heart and BV. |
| Name some Sympatholytics. | B-Adrenergic blockers, Alpha 2 agonists, Alpha 1 adrenergic Antagonists, Alpha 1/Beta blocker combos |
| Name some B-Adrenergic Blockers. | Propranolol, metoprolol |
| What are the adverse effects of B-adrenergic blockers? | Bizarre dreams, Sexual dysfxn, bradycardia, heart block, depression, insomnia |
| Name an Alpha 2 agonist. | Clonidine |
| How doe Alpha 2 agonists work? | Act in brain to ↓ SNS tone |
| What are adverse effects of Alpha 2 agonists? | Dry mouth, Sedation |
| Name an Alpha 1 adrenergic antagonist. | Prazosin |
| How doe Alpha 1 adrenergic antagonists work? | Block Vasoconstriction |
| What are the adverse effects of Alpha 1 Adrenergic antagonists? | Orthostatic hypotension |
| What is Hydralazine? | It is a direct acting vasodilator used to ↓ Blood pressure by dilating arterioles. |
| What are the adverse effects of Hydralazine? | Lupus-like syndrome |
| How do CCB work? | ↓BP by dilating arterioles. |
| Name a CCB in the Dihydropyridine class. | Nifedipine |
| Since Nifedpine is a CCB, what are its adverse effects? | Ankle edema, reflex tachycardia |
| What are the adverse effects of ACE inhibitors? | Persistent "tickle" cough, first does hypotension, HYPERKALEMIA |
| Can ACE inhibitors be taken during pregnancy? | They cause fetal harm during the 2nd and 3rd trimesters of pregnancy. |
| What is an ARB? | an Angiotensin Receptor Antagonist |
| Can ARB's be taken during pregnancy? | They are harmful during the 2nd and 3rd trimester fetus. |
| Name an Angiotensin II Receptor Antagonist (ARB). | Losartan |
| Name a Directe Renin Inhibitor. | Aliskiren, cause fetal harm |
| Where do THIAZIDEs work at? | Vascular Smooth Muscle |
| Where does FUROSEMIDE, K Sparing Diuretics, and Thiazide Diuretics work at? | Renal Tubules |
| Where do Beta Blockers such as Propranolol and Metoprolol work at? | Cardiac Beta 1 receptors |
| Since Prazosin is a Alpha 1 blocker, where does Prazosin work at? | Vascular Receptors to cause vasodilation |
| Where do Clonidine and Methyldopa work at? | Brainstem |
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