Block 4 Pharmacology Final Exam
How venodilator treatment reduces preload/end-diastolic volume - by decreasing
venous return
How harterial hdilator htreatment hreduces hafterload/end-systolic hvolume h- hby
hdecreasing harterial/aortic hpressure
Description hof hO2 hsupply hof hheart h- hATP hsynth hby haerobic hmetab hw/ hinterm hO2
hsupply h(not hcontinuous hbl hsupp hb/c hBVs hsupp hmyocard hconstr hduring hsystole)
- extr hup hto h70% hO2 hfrom hblood
Pathophysiology hof hIHD h- h1). hStable hangina h= hchron hdisr hbl hsupp hto hmyocard
htiss hby hasymp hathero hplaque
2). Stable hischemia/angina h= hstab hfixed hathero hplaque
3). Unstable hischemia/angina h= hplaque hdisr+plt haggreg hbut hnot hyet hthrombus
hformation
4). NSTEMI h= hthrombus hform hbut hnot hcompl hocclusive
5). STEMI h= hcompl hoccl hthromb
Angina hPectoris hDescription h& hTypes h- hpress-like hdiscomf/pain hfrom hmyocard
hisch/underl hathero h--> hO2 hdem>O2 hsupp
- IHD h= hangina+MI
- Typ hang h= hO2 hdem hincr h(ie. hexerc/stress) hbut hcor hbl hfl+O2 hsupp hlim hby hathero
- Stab hang h= hsim hangina hattacks heach htime
- Unstab hang h= hang hattacks hworse heach htime hby hrup hplaque; hMI hforerunner
- Variant/Prinzmetal's hang h= hac hcor hvasosp hw/ hpain h@ hrest h--> hTREAT hw/
hCCBs/BBs
Drug hClasses hused hfor hStable hAngina hTreatment h- h- hNitrites h& hNitrates
- CCBs
- BBs
- Drugs hmodifying hmyocard hmetab
General hPharmacology hof hDrugs hfor hStable hAngina hTreatment h- h- hIncr hO2 hsupp
hby: hincr hreg hfl hdistrib hby hnitrates, hCCBs, hBBs h& hincr hcor hbl hfl hby hnitrates,
hCCBs
- Decr hO2 hdem hby: hdecr hHR+contractility hby hBBs, hCCBs h& hdecr hwall htens
h(pre+afterload) hby hnitrates, hCCBs
Examples h& hUse hof hNitrites hin hStable hAngina hTreatment h- hAmyl hnitrite hfor hac hang
hby hinhal
Examples h& hUse hof hNitrates hin hStable hAngina hTreatment h- hincl hnitroglycerin,
hisosorbide hdinitrate, hisosorbide hmononitrate
- Use h= hprev+treat hang hattacks hby hpref hrelax hven hsm hmusc h(venodil)
- IV hnitro halso hfor hMI-assoc hac hHF
MOA h& hEffects hof hNitrites h& hNitrates hin hStable hAngina hTreatment h- h- hMOA h=
hbiotransf hprod hNO hactiv hguanylyl hcyl h--> hcGMP h-->sm hmusc hrelax h--> hvasodil
h(pref hin hveins)
- Effects h= hpref hdil hven hsm hmusc hto hred hpreload h--> hdecr hvent hwall htens h--> hdecr
,Block 4 Pharmacology Final Exam
hO2 hdem; hcor hart hdil h--> hincr hcor hbl hfl+distrib hto hsubendoc h--> hincr hO2 hsupp
,Block 4 Pharmacology Final Exam
Onset h& hDuration hof hAction hof hNitroglycerin, hIsosorbide hdinitrate, hIsosorbide
hmononitrate
- - hSL hNitro h= honset h2 hmins, hdur h25 hmins
- PO hsust-rel hNitro h= honset h35 hmins, hdur h4-8 hhrs
- TD hNitro h= honset h30 hmins, hdur h8-14 hhrs h**useful hfor hprev hnocturnal hangina**
- SL hIsoD h= honset h5 hmins, hdur h1 hhr
- PO hslow-rel hIsoD h= honset h30 hmins, hdur h8 hhrs
- PO hext-rel hIsoM h= honset h30 hmins, hdur h12 hhrs
Therapeutic hUses h& hAEs hof hNitrates h- h- hUses h= hprev+treat hang hattacks
- AEs h= hexcess hvasodil h--> hHA, hhypoTN, hdizz; hrefl htachy hby hsympa hstim h--> hincr
hO2 hdem hso hBB hw/ hnitrate hto hprev htachy; hTolerance hby hmitoch haldehyde
hdehydrog hinactiv hbiotransf hnitro h--> hinterrupt hther hfor h8-10hr/day hto hrestore hresp
DIs hfor hNitrates h- hw/ hSildenafil h(Viagra) hfor hED h--> hserious hhypoTN
Types hof hCa hChannels hin hSmooth hMuscle hCells h& hCardiomyocytes h- h- hSm
hmusc hcells h= hL+T-type h--> hvasocon
- Cardiomyocytes h= hL-type honly h--> hcard hcontractility, hSA hautomaticity, hAV hcond hvel
Examples h& hPotency hof hDihydropyridine hCCBs h- h- hAmlodipine
- Felodipine
- Isradipine
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
potent hvasodils hw/ hmin/no heffect hon hheart, hMOSTLY h@ hBVs hfor hstab/var hangina
htreatment
**incr hO2 hsupp**
Examples h& hPotency hof hPhenylalkylamine h& hBenzothiazepine hCCBs h- h-
hVerapamil h(phenylalkylamine) h& hDiltiazem h(benzothiazepine)
act h@ hboth hheart h& hBVs h--> hdecr hSA hnode hautom, hdecr hAV hnode hcond hvel,
hdecr hcard hcontractility hfor hstab/var hangina htreatment
**incr hO2 hsupp+decr hO2 hdem**
**SUPERIOR hfor hIHD htreatment**
Other huses hfor hCCBs haside hfrom hAngina hTreatment h- h- hHTN
- Verap+Dilt hfor harrhyth
- Nimodipine hfor hSAH
, Block 4 Pharmacology Final Exam
AEs, hDIs, hCIs hfor hCCBs h- h- hAEs h= hfatigue, hHA, hdizz, hflush, hperiph hed hby
hvasodil/hypoTN; hgingiv hhyperpl; hDihydropyr h--> hrefl htachy/arrhyth hby hpot hvasodil;
hVerap, hDilt, hBepridil h--> harrhyth
- DIs h= hVerap+Dilt hred hdigoxin hclear h--> hrisk hdig htox
- CIs h= hVerap+Dilt hCI hin hac hHF hpts hb/c h-inotropic heffects
Nitrates+BBs hcombo hfor hangina h- h- hexertional/stab hang htreatment
- BB hprev hrefl htachy h& h+inotrop heffects hnitrates
CCBs+Nitrates hcombo hfor hangina h- hadditive heffs hw/ hCCBs hred hafterl, hnitr hred hprel
h--> hdecr hO2 hdem; hboth hdil hcor harts hto hincr hO2 hsupp
CCBs+BBs+Nitrates hcombo hfor hangina h- hfor hexert hang hnot hcontr hby
hNitrates+BBs/CCBs+Nitrates hbut hincr hSEs
- CCBs hto hred hafterl h& hnitrates hto hred hprel h--> hdecr hO2 hdem
- CCBs+nitr hdil hcor harts h--> hincr hO2 hsupp
- BBs hred hHR+contractility h--> hdecr hO2 hdem
MOA hof hBBs hin hAngina hTreatment h- h1). h- hinotr heff hby hdecr hcontractility h& h-
hchronotr heff hby hdecr hHR h--> hdecr hO2 hdem
2). hmaybe hincr hbl hfl hto hisch harea h--> hincr hO2 hsupp
Therapeutic hUses hof hBBs hin hAngina h& hMI hTreatment h- h- hbeta-1 hsel
hAtenolol+Metoprolol h& hnonsel hNadolol+Propranolol hfor hstab hang htreatment
- unstab hang htreatment hby hred hrecur hisch hepisodes+progr hto hac hMI
- ac hMI hby hred hSCD hdue hto hac hvent harrhyth
- NOT hfor hvar hang hb/c hNOT heffective hin hvasodil h(USE hCCB hinstead)
Other hTherapeutic hUses hof hBBs haside hfrom hAngina hTreatment h- h- hHTN
- Card harrhyth
- CHF
AEs hof hBBs hfor hAngina hTreatment h- h- hworsen hac hHF hby h-inotr heffs hbut hLOW
hdose hfor hchron hHF hto hred hmyocard hremod
- nonsel hB2 hblock h--> hbronchocon h(USE hB1-sel)
MOA hof hRanolazine hfor hAngina hTreatment h- hmodif hmyocard hby hinhib hFA hoxid h&
hinhib hNa+influx+cardiomyo hCa hoverl h--> hred hdiast hrelax hfailure, hincr hgluc hoxid+incr
hefficient hO2 hutil hby hheart
Uses h& hAEs hof hRanolazine hfor hAngina hTreatment h- h- hUses h= himprov hexerc hcap,
hred hang hattack hfreq, hred hnitro huse; h2nd hLINE hfor hchron hstab hang
- AEs h= hnausea, hconstip, hdizz, h**QT hprolong**
Stable hAngina hTreatment hAlgorithm h- h1). hStab hIHD h--> hguideline-dir hmed
hther+lifestyle hmodifs hfor hCV hrisk hred
How venodilator treatment reduces preload/end-diastolic volume - by decreasing
venous return
How harterial hdilator htreatment hreduces hafterload/end-systolic hvolume h- hby
hdecreasing harterial/aortic hpressure
Description hof hO2 hsupply hof hheart h- hATP hsynth hby haerobic hmetab hw/ hinterm hO2
hsupply h(not hcontinuous hbl hsupp hb/c hBVs hsupp hmyocard hconstr hduring hsystole)
- extr hup hto h70% hO2 hfrom hblood
Pathophysiology hof hIHD h- h1). hStable hangina h= hchron hdisr hbl hsupp hto hmyocard
htiss hby hasymp hathero hplaque
2). Stable hischemia/angina h= hstab hfixed hathero hplaque
3). Unstable hischemia/angina h= hplaque hdisr+plt haggreg hbut hnot hyet hthrombus
hformation
4). NSTEMI h= hthrombus hform hbut hnot hcompl hocclusive
5). STEMI h= hcompl hoccl hthromb
Angina hPectoris hDescription h& hTypes h- hpress-like hdiscomf/pain hfrom hmyocard
hisch/underl hathero h--> hO2 hdem>O2 hsupp
- IHD h= hangina+MI
- Typ hang h= hO2 hdem hincr h(ie. hexerc/stress) hbut hcor hbl hfl+O2 hsupp hlim hby hathero
- Stab hang h= hsim hangina hattacks heach htime
- Unstab hang h= hang hattacks hworse heach htime hby hrup hplaque; hMI hforerunner
- Variant/Prinzmetal's hang h= hac hcor hvasosp hw/ hpain h@ hrest h--> hTREAT hw/
hCCBs/BBs
Drug hClasses hused hfor hStable hAngina hTreatment h- h- hNitrites h& hNitrates
- CCBs
- BBs
- Drugs hmodifying hmyocard hmetab
General hPharmacology hof hDrugs hfor hStable hAngina hTreatment h- h- hIncr hO2 hsupp
hby: hincr hreg hfl hdistrib hby hnitrates, hCCBs, hBBs h& hincr hcor hbl hfl hby hnitrates,
hCCBs
- Decr hO2 hdem hby: hdecr hHR+contractility hby hBBs, hCCBs h& hdecr hwall htens
h(pre+afterload) hby hnitrates, hCCBs
Examples h& hUse hof hNitrites hin hStable hAngina hTreatment h- hAmyl hnitrite hfor hac hang
hby hinhal
Examples h& hUse hof hNitrates hin hStable hAngina hTreatment h- hincl hnitroglycerin,
hisosorbide hdinitrate, hisosorbide hmononitrate
- Use h= hprev+treat hang hattacks hby hpref hrelax hven hsm hmusc h(venodil)
- IV hnitro halso hfor hMI-assoc hac hHF
MOA h& hEffects hof hNitrites h& hNitrates hin hStable hAngina hTreatment h- h- hMOA h=
hbiotransf hprod hNO hactiv hguanylyl hcyl h--> hcGMP h-->sm hmusc hrelax h--> hvasodil
h(pref hin hveins)
- Effects h= hpref hdil hven hsm hmusc hto hred hpreload h--> hdecr hvent hwall htens h--> hdecr
,Block 4 Pharmacology Final Exam
hO2 hdem; hcor hart hdil h--> hincr hcor hbl hfl+distrib hto hsubendoc h--> hincr hO2 hsupp
,Block 4 Pharmacology Final Exam
Onset h& hDuration hof hAction hof hNitroglycerin, hIsosorbide hdinitrate, hIsosorbide
hmononitrate
- - hSL hNitro h= honset h2 hmins, hdur h25 hmins
- PO hsust-rel hNitro h= honset h35 hmins, hdur h4-8 hhrs
- TD hNitro h= honset h30 hmins, hdur h8-14 hhrs h**useful hfor hprev hnocturnal hangina**
- SL hIsoD h= honset h5 hmins, hdur h1 hhr
- PO hslow-rel hIsoD h= honset h30 hmins, hdur h8 hhrs
- PO hext-rel hIsoM h= honset h30 hmins, hdur h12 hhrs
Therapeutic hUses h& hAEs hof hNitrates h- h- hUses h= hprev+treat hang hattacks
- AEs h= hexcess hvasodil h--> hHA, hhypoTN, hdizz; hrefl htachy hby hsympa hstim h--> hincr
hO2 hdem hso hBB hw/ hnitrate hto hprev htachy; hTolerance hby hmitoch haldehyde
hdehydrog hinactiv hbiotransf hnitro h--> hinterrupt hther hfor h8-10hr/day hto hrestore hresp
DIs hfor hNitrates h- hw/ hSildenafil h(Viagra) hfor hED h--> hserious hhypoTN
Types hof hCa hChannels hin hSmooth hMuscle hCells h& hCardiomyocytes h- h- hSm
hmusc hcells h= hL+T-type h--> hvasocon
- Cardiomyocytes h= hL-type honly h--> hcard hcontractility, hSA hautomaticity, hAV hcond hvel
Examples h& hPotency hof hDihydropyridine hCCBs h- h- hAmlodipine
- Felodipine
- Isradipine
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
potent hvasodils hw/ hmin/no heffect hon hheart, hMOSTLY h@ hBVs hfor hstab/var hangina
htreatment
**incr hO2 hsupp**
Examples h& hPotency hof hPhenylalkylamine h& hBenzothiazepine hCCBs h- h-
hVerapamil h(phenylalkylamine) h& hDiltiazem h(benzothiazepine)
act h@ hboth hheart h& hBVs h--> hdecr hSA hnode hautom, hdecr hAV hnode hcond hvel,
hdecr hcard hcontractility hfor hstab/var hangina htreatment
**incr hO2 hsupp+decr hO2 hdem**
**SUPERIOR hfor hIHD htreatment**
Other huses hfor hCCBs haside hfrom hAngina hTreatment h- h- hHTN
- Verap+Dilt hfor harrhyth
- Nimodipine hfor hSAH
, Block 4 Pharmacology Final Exam
AEs, hDIs, hCIs hfor hCCBs h- h- hAEs h= hfatigue, hHA, hdizz, hflush, hperiph hed hby
hvasodil/hypoTN; hgingiv hhyperpl; hDihydropyr h--> hrefl htachy/arrhyth hby hpot hvasodil;
hVerap, hDilt, hBepridil h--> harrhyth
- DIs h= hVerap+Dilt hred hdigoxin hclear h--> hrisk hdig htox
- CIs h= hVerap+Dilt hCI hin hac hHF hpts hb/c h-inotropic heffects
Nitrates+BBs hcombo hfor hangina h- h- hexertional/stab hang htreatment
- BB hprev hrefl htachy h& h+inotrop heffects hnitrates
CCBs+Nitrates hcombo hfor hangina h- hadditive heffs hw/ hCCBs hred hafterl, hnitr hred hprel
h--> hdecr hO2 hdem; hboth hdil hcor harts hto hincr hO2 hsupp
CCBs+BBs+Nitrates hcombo hfor hangina h- hfor hexert hang hnot hcontr hby
hNitrates+BBs/CCBs+Nitrates hbut hincr hSEs
- CCBs hto hred hafterl h& hnitrates hto hred hprel h--> hdecr hO2 hdem
- CCBs+nitr hdil hcor harts h--> hincr hO2 hsupp
- BBs hred hHR+contractility h--> hdecr hO2 hdem
MOA hof hBBs hin hAngina hTreatment h- h1). h- hinotr heff hby hdecr hcontractility h& h-
hchronotr heff hby hdecr hHR h--> hdecr hO2 hdem
2). hmaybe hincr hbl hfl hto hisch harea h--> hincr hO2 hsupp
Therapeutic hUses hof hBBs hin hAngina h& hMI hTreatment h- h- hbeta-1 hsel
hAtenolol+Metoprolol h& hnonsel hNadolol+Propranolol hfor hstab hang htreatment
- unstab hang htreatment hby hred hrecur hisch hepisodes+progr hto hac hMI
- ac hMI hby hred hSCD hdue hto hac hvent harrhyth
- NOT hfor hvar hang hb/c hNOT heffective hin hvasodil h(USE hCCB hinstead)
Other hTherapeutic hUses hof hBBs haside hfrom hAngina hTreatment h- h- hHTN
- Card harrhyth
- CHF
AEs hof hBBs hfor hAngina hTreatment h- h- hworsen hac hHF hby h-inotr heffs hbut hLOW
hdose hfor hchron hHF hto hred hmyocard hremod
- nonsel hB2 hblock h--> hbronchocon h(USE hB1-sel)
MOA hof hRanolazine hfor hAngina hTreatment h- hmodif hmyocard hby hinhib hFA hoxid h&
hinhib hNa+influx+cardiomyo hCa hoverl h--> hred hdiast hrelax hfailure, hincr hgluc hoxid+incr
hefficient hO2 hutil hby hheart
Uses h& hAEs hof hRanolazine hfor hAngina hTreatment h- h- hUses h= himprov hexerc hcap,
hred hang hattack hfreq, hred hnitro huse; h2nd hLINE hfor hchron hstab hang
- AEs h= hnausea, hconstip, hdizz, h**QT hprolong**
Stable hAngina hTreatment hAlgorithm h- h1). hStab hIHD h--> hguideline-dir hmed
hther+lifestyle hmodifs hfor hCV hrisk hred
