namf
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An old man going up a hill feels a stabbing chest pain. He stops to take some medication, after which he is able to continue. What is the drug's MOA?
Decreased afterload
Decreased preload
Increased afterload and preload
Increased preload
Increased contractility
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| Ria
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Hi namf,I havent done Pharmacology yet but I think that increased contractility should be the best choice cause
1.he is going against gravity therefore increased work is being done,for the pain his CO might have decreased (ischemic pain) so when we give a drug that increases contractility CO increases and pain subsides.
I hope I am correct,if I am not then my entire concept is wrong.But do let me know what the answer for the question is.
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| Ahab
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If he took a GTN spray or the likes there would be vasodilation resulting in reduced afterload?
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| mdwannabe
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Nitro...best works on veins...so decreased preload. But also has action on arteriols..so decresed afterload can be a correct answer..incase preload is not an option. In this case .... Preload is best choice.
Ria... if u increase contractility in man with CAD..u increase work of heart, increase O2 demand...increase ischemia...and PAIN.
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| Ria
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oops you are right mdwannabe,i didnt think about that.I am sorry namf for misleading yoou
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| mani
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agree with mdwannabe, its decreased preload
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| namf
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Thank you all--i am sorry to say this comes from a source that I have no answer for, so I trust the group concensus here/
Great! 
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| mdwannabe
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make sure you understand that it is both Pre and After...only Pre is affected more.
Tell us the actual mechanism in Nitro use?
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| mani
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nitrates dilate both arteries and veins, so reduce both pre and after load and also dilate coronary arteries. major affect is on preload
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| tonguo
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here is a point from Katzung: nitrite/nitrate vasodilators were incorrectly called coronary vasodilators, which is not the primary mechanism of their antiangina effects. it also mentioned that nitrate/nitrite vasodilators can both increase the oxygen supply to heart and decrease its O2 requirement. i understand the decrease O2 require part, but could anyone explain how does it increase O2 supply to heart? through its 'minor' coronary dilating effect?
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| mani
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yes, imp word is "primary". u are rite tongu, increase in blood supply is thru coronary vasodilation. there is systemic vasodilation as well although much less effective than venous dilatation
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| tonguo
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mani, thanks a lot for ur post! tong
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| mani
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u r welcome
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