Drugs Used In Angina & Vasodilators at Wayamba University Of Sri Lanka | Flashcards & Summaries

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Lernmaterialien für Drugs used in angina & vasodilators an der Wayamba University of Sri Lanka

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TESTE DEIN WISSEN
What's the mechanism of angina?
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TESTE DEIN WISSEN
  • The angina pain occurs due to imbalance between the oxygen requirement and oxygen supply in the ischemic area of the myocardium
  • Resulting anerobic metabolism leads to accumulation of acidic metabolites, which stimulates myocardial pain-mediating nerve ending
Lösung ausblenden
TESTE DEIN WISSEN
What provokes Classical angina?
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TESTE DEIN WISSEN
provoked by exercise, emotion or meals (gut blood supply increases. So O2 has to be increased. Work load increases)
Lösung ausblenden
TESTE DEIN WISSEN
What are the types of angina?
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TESTE DEIN WISSEN
Classical or stable angina (effort or exertional angina)
• Crescendo or unstable angina (Preinfarction angina)
• Variant or Prinzmetal angina (Vasospastic angina)
Lösung ausblenden
TESTE DEIN WISSEN
What's the mechanism behind nitrates?
Lösung anzeigen
TESTE DEIN WISSEN
Organic nitrates are rapidly denitrated enzymatically in the smooth muscle
• Release the reactive free radical nitric oxide (NO)
• NO activates cytosolic guanylyl cyclase, increasing cGMP
• Increased cGMP cause, dephosphorylation of myosin light chain PO4 via cGMP dependent protein kinase
• This cause failure of myosin interacting with actin causing muscle relaxation
• Results in relaxation of vascular smooth muscle
Lösung ausblenden
TESTE DEIN WISSEN
What are the 4 different function of nitrates?
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TESTE DEIN WISSEN
• Cause direct dilatation of obstructed coronary vessels
• Preload reduction
• Afterload reduction
• Redistribution of coronary blood flow
Lösung ausblenden
TESTE DEIN WISSEN
How does nitrate reduce preload?
Lösung anzeigen
TESTE DEIN WISSEN
• Preload of the heart is the volume of blood a ventricles has when it begins to contract (end diastolic volume)
• Nitrates dilate both veins and arteries
• Effects on veins is more than on arteries
• Dilatation of capacitance vessels causing pooling of blood in veins
• Decrease venous return to the heart → reduce end diastolic volume and pressure →decrease myocardial wall tension →decrease cardiac workload→ decrease myocardial oxygen demand → relief of angina pain
Lösung ausblenden
TESTE DEIN WISSEN
How does nitrate reduce afterlord?
Lösung anzeigen
TESTE DEIN WISSEN
Arteriolar dilatation → slightly decrease total peripheral vascular resistance → decreased resistance to left ventricular ejection → decrease afterload on heart →reduce myocardial wall tension →myocardial O2 demand → relief from angina pain
Lösung ausblenden
TESTE DEIN WISSEN
How does nitrate cause redistribution of coronary blood flow?
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TESTE DEIN WISSEN
Blood flow to the subendocardial region is primarily during diastole

• Reduction in left ventricular end-diastolic pressure by nitrates → reduces extravascular compression of subendocardial vessels →favors blood flow to subendocardial area which is particularly vulnerable to ischemia → increase in myocardial O2 supply → relief of pain

• Nitrates cause selective vasodilatation of large epicardial vessels and redistribution of coronary blood flow to ischemic subendocardial vessels by opening collaterals, without increasing total coronary blood flow
Lösung ausblenden
TESTE DEIN WISSEN
Other causes of organic nitiate
Lösung anzeigen
TESTE DEIN WISSEN
MI 
Congestive HF
esophageal spasm
Biliary colic
Cyanide poisoning
Lösung ausblenden
TESTE DEIN WISSEN
Why nitroglycerine used through sublingual route in acute attack of angina
Lösung anzeigen
TESTE DEIN WISSEN
• Nitrates are rapidly inactivated in the liver by glutathione-organic nitrate reductase
• Their oral bioavailability is considerably less due to high first pass metabolism
• Sublingual route of administration bypass the first-pass effect
• Though therapeutic blood levels are reached within minutes of sublingual administration of nitroglycerine, the total duration of action lasts only about 25-30 min, due to rapid metabolism.
Lösung ausblenden
TESTE DEIN WISSEN
What are the routes of nitrates?
Lösung anzeigen
TESTE DEIN WISSEN
• Sublingual– acute angina
• Oral – long acting sustained release preparations can be used for prophylaxis
• Transdermal patch – to prevent angina, not treat an acute attack
• Intravenous - intravenous nitroglycerin is restricted to the treatment of severe or unstable angina
Lösung ausblenden
TESTE DEIN WISSEN
What are the adverse effects of nitrates?
Lösung anzeigen
TESTE DEIN WISSEN
• Orthostatic hypotension
• Tachycardia
• Palpitations
• Throbbing headache
• Flushing of face
• Dizziness
• sweating
• Fainting
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Q:
What's the mechanism of angina?
A:
  • The angina pain occurs due to imbalance between the oxygen requirement and oxygen supply in the ischemic area of the myocardium
  • Resulting anerobic metabolism leads to accumulation of acidic metabolites, which stimulates myocardial pain-mediating nerve ending
Q:
What provokes Classical angina?
A:
provoked by exercise, emotion or meals (gut blood supply increases. So O2 has to be increased. Work load increases)
Q:
What are the types of angina?
A:
Classical or stable angina (effort or exertional angina)
• Crescendo or unstable angina (Preinfarction angina)
• Variant or Prinzmetal angina (Vasospastic angina)
Q:
What's the mechanism behind nitrates?
A:
Organic nitrates are rapidly denitrated enzymatically in the smooth muscle
• Release the reactive free radical nitric oxide (NO)
• NO activates cytosolic guanylyl cyclase, increasing cGMP
• Increased cGMP cause, dephosphorylation of myosin light chain PO4 via cGMP dependent protein kinase
• This cause failure of myosin interacting with actin causing muscle relaxation
• Results in relaxation of vascular smooth muscle
Q:
What are the 4 different function of nitrates?
A:
• Cause direct dilatation of obstructed coronary vessels
• Preload reduction
• Afterload reduction
• Redistribution of coronary blood flow
Mehr Karteikarten anzeigen
Q:
How does nitrate reduce preload?
A:
• Preload of the heart is the volume of blood a ventricles has when it begins to contract (end diastolic volume)
• Nitrates dilate both veins and arteries
• Effects on veins is more than on arteries
• Dilatation of capacitance vessels causing pooling of blood in veins
• Decrease venous return to the heart → reduce end diastolic volume and pressure →decrease myocardial wall tension →decrease cardiac workload→ decrease myocardial oxygen demand → relief of angina pain
Q:
How does nitrate reduce afterlord?
A:
Arteriolar dilatation → slightly decrease total peripheral vascular resistance → decreased resistance to left ventricular ejection → decrease afterload on heart →reduce myocardial wall tension →myocardial O2 demand → relief from angina pain
Q:
How does nitrate cause redistribution of coronary blood flow?
A:
Blood flow to the subendocardial region is primarily during diastole

• Reduction in left ventricular end-diastolic pressure by nitrates → reduces extravascular compression of subendocardial vessels →favors blood flow to subendocardial area which is particularly vulnerable to ischemia → increase in myocardial O2 supply → relief of pain

• Nitrates cause selective vasodilatation of large epicardial vessels and redistribution of coronary blood flow to ischemic subendocardial vessels by opening collaterals, without increasing total coronary blood flow
Q:
Other causes of organic nitiate
A:
MI 
Congestive HF
esophageal spasm
Biliary colic
Cyanide poisoning
Q:
Why nitroglycerine used through sublingual route in acute attack of angina
A:
• Nitrates are rapidly inactivated in the liver by glutathione-organic nitrate reductase
• Their oral bioavailability is considerably less due to high first pass metabolism
• Sublingual route of administration bypass the first-pass effect
• Though therapeutic blood levels are reached within minutes of sublingual administration of nitroglycerine, the total duration of action lasts only about 25-30 min, due to rapid metabolism.
Q:
What are the routes of nitrates?
A:
• Sublingual– acute angina
• Oral – long acting sustained release preparations can be used for prophylaxis
• Transdermal patch – to prevent angina, not treat an acute attack
• Intravenous - intravenous nitroglycerin is restricted to the treatment of severe or unstable angina
Q:
What are the adverse effects of nitrates?
A:
• Orthostatic hypotension
• Tachycardia
• Palpitations
• Throbbing headache
• Flushing of face
• Dizziness
• sweating
• Fainting
Drugs used in angina & vasodilators

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