parmRxCAD
Terms
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At the end of this session the student will be able to
discuss the principles and strategies of treating IHD - differentiate myocardial oxygen demand and supply issues
discuss the different drug groups used in the treatment of IHD and their mech - these are from the ITO
- if you have a bigger demand in the myocardium for o2 than you have a supply of what happens?
- angina... a symptomatic manifestation of myocardial ischemia
- what is the major underlying cause of classic angina?
- coronary atherosclerosis
- what is another name of variant angina? and what is the underlying cause?
- prinzmetal angina and coronary vasospasm
- what is a clinical test of variant/printzmetal angina?
- ergonovine provocative test
- what are clinical managments of variant angina?
- pharmacologic: coronary vasodialators to prevent vasospasm
- whta is the major underlying cause of unstable angina? what type of drugs are given?
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coronary thrombosis ... thrombolytic drugs
aspirin clopidogrel streptokinase rTPA 9tissue plasminogen activator) - if IVP (intraventricular pressure increases) tension increases or decreases according to la places law?
- tension increases
- as the radius of the heart increases, the LV wall tension or load on the heart increases or decrease?
- increases
- an increased tenions or load on the heart like lv wall tension leads to a increase or decrease in myocardial o2 demand?
- increase
- nitroglycerin increases or decreases the ventricle diameter? icreases or decreases the systolic pressure
- decreases both
- nitroglycerine increases or decreases heart rate? contractility?
- increases
- propranolo increases or decreases systolic bp, heart rate, contractility?
- decreases all
- propranolo increases or decreases ventricle diameter?
- increases
- what are three primary anti anginal agents?
- nitrates nitrites, b blockers, ca channel blockers
- ranolazine is a 2ndary antianginal agent. what are some unique features of it?
- no change in hr, and no change in bp, preserve tissue atp, and decrease CA overload
- nicorandil and fasudil are what kinda drugs?
- secondary anti anginal
- nitrates and nitrites increase or decrease calcium which leads to what?
- decrease calcium concentration and leads to relaxation
- cGMP mediated vasorelaxation occurs by what change in intracellular ion concentration
- calcium
- what is the second messenger of NO mediated vasodialation
- cGMP
- is NO short or long acting for local or widespread control?
- short acting thus mostly fro local control
- what is a side effect of NO
- ED
- how does slidenafil - viagra work
- inhib of phosphodiesterase V prolongs cGMP activity and vasodialates and hence prolongs the erection
- myocardia precondition is what
- Single or multiple brief periods of ischemia result in a marked reduction in myocardial injury (infarction) when the hearts are exposed to a more prolonged period of ischemia
- what are the two phases of myocardial preconditioning?
- acute and delayed
- a pt has been taking an antianginal agent and has a headache, flushing senstaion, postural hypotension due to venous pooling and dizziness. she aslo has methemoglobinemia... what drug caused these adverse side effects?
- nitrates and nitrites
- why do u use caution when withdrawing from b blockers
- upreg of b blocker receptors
- what drug primarily decreases myocardial o2 demands among the anti anginal agents?
- beta blockers
- how do calcium channel blockers work as anti anginal agents?
- primarily ca channel blockers work to decrease myocardial o2 demands and increase 02 supply via coronary vasodilatory action
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name a class I phenylalkyamine
class II benzothiazepine - verapamil
- name a class II benzothiazepine
- diltiazem
- name a class II 1,4-dihyropyridine
- nifedipine