Angina & Heart Failure PHARM(Congestive Heart Failure)

Angina & Heart Failure PHARM(Congestive Heart Failure) goal of therapy for angina Ans- 1. increase blood supply (vasodilation) 2. decrease work on the heart 4 ways to regulate vascular tone: Ans- 1. INCREASE cGMP: you do this by giving nitric oxide (which activates cGMP). If you increase cGMP you will have more dephosphorylation of myosin which prevents a reaction with actin and see muscle relaxation 2. DECREASE INTRACELLULAR CALCIUM: you do this by giving CCB which decreases intracellular CA and doesn't activate MLCK which is an important step in contraction (so prevents contraction) 3. STABILIZE/PREVENT DEPOLARIZATION OF VASCULAR SMOOTH MUSCLE: membrane potential is stabilized by increased potassium permeability 4. INCREASE CAMP in vascular cells: increase rate of deactivation of MLCK so prevents contraction Use of Nitrates/Nitrite 1. Name 2. MOA 3. Side Effects 4. Dosing Strategy 5. Coronary Steal 6. contraindications Ans- 1. Nitroglycerin, Nitroprusside, Isosorbide di-nitrate and mononitrate 2. releases nitric oxide once absorbed (which activates cGMP). If you increase cGMP you will have more dephosphorylation of myosin which prevents a reaction with actin and see muscle relaxation (vasodilation) 3. Hypotension and headache and reflex tachycardia 4. asymmetric dosing: make sure to have a period in the day without medication/patch so body won't build tolerance