(11.1) Drugs Used in Chronic Ischemic Heart Disease (Konorev)

Question 1

How is chronic ischemic heart disease characterized?

Answer 1

PARTIAL occlusion of coronary artery

Question 2

What are some examples of chronic ischemic heart disease?

Answer 2

• Angina
• Variant (Prinzmental) angina

Question 3

Angina:

What causes?

When do symptoms occur?

Answer 3

Occlusion of coronary arteries resulting from the formation of atherosclerotic plaque

Symptoms occur during exertion/stress

Question 4

Variant (Prinzmental) angina:

What causes?

When do symptoms occur?

Answer 4

Episodes of vasoconstriction of coronary arteries

Symptoms occur at rest

Question 5

What are the two general approaches to treat angina?

Answer 5

• Decrease cardiac work
• Increase blood flow through coronary arteries

Question 6

What is a direct approach to treat angina?

Answer 6

Surgical:

To increase (or restore) coronary blood flow

-Atherectomy : Tip of catheter shears off the plaque

• Coronary artery bypass grafting
• Percutaneous transluminal coronary angioplasty (PTCA)

-Stent : Expandable tube used as scaffolding to keep vessel open

Question 7

What pharmacologic agents can be used to treat vasospastic (Prinzmetal) angina?

Answer 7

Vasodilators

Question 8

Can you use vasodilators to treat angina pectoris?

Answer 8

NO!

Vasodilators are NOT useful in atherosclerotic angina

Due to “coronary steal” phenomenon : Administering a arteriolar vasodilator will FURTHER exacurbate the ischemic area by further dilating the perfused myocardium and increasing blood flow to healthy tissue

Question 9

What is the best way to treat angina pectoris?

Answer 9

DECREASE myocardial oxygen demand

Question 10

Answer 10

C. Pilocarpine

Question 11

What are the three classes of drugs used in chronic IHD?

Answer 11

Nitrates (nitrovasodilators)

Calcium channel blockers

Beta-blockers

Question 12

What are the 3 nitrovasodilator drugs?

Answer 12

Nitroglycerin

Isosorbide dinitrate

Isosorbide mononitrate

Question 13

Describe the MOA of nitrates

Answer 13

Question 14

What is a major drawback of using nitrates?

Answer 14

Development of tolerance

Question 15

Describe the mechanism of nitrate tolerance

Answer 15

Depletion of thiol compounds

Increased generation of superoxide radicals

Reflex activation of sypmathetic nervous system (tachycardia, decreased coronary supply)

Retention of salt and water

Question 16

Answer 16

E. Activation of protein kinase G

Question 17

What are the two categories of calcium channel blockers used in the treatment of angina?

Answer 17

Non-cardioactive

Cardioactive

Question 18

What are the non-cardioactive CCBs?

Answer 18

Amlodipine

Nifedipine

Nicardipine

Question 19

Which of the non-cardioactive CCBs are long acting vs short acting?

Answer 19

Amlodipine = long acting, t1/2=30-50h

Nifedipine = short acting, t1/2=4h

Nicardipine = short acting, t1/2=2-4h

Question 20

What are the cardioactive CCBs?

Answer 20

Diltiazem

Verapamil

Question 21

Describe the MOA of calcium channel blockers

Answer 21

Ca2+ channel blockers inhibit Ca2+ from entering the cell to cause contraction

Question 22

What beta-blockers are indicated in angina?

Answer 22

Propranolol

Nadolol

Metoprolol

Atenolol

Question 23

What is the MOA of beta blockers in the treatment of angina?

Answer 23

Decreased myocardial oxygen demand

Question 24

Answer 24

D. Decreased coronary vascular tone

Question 25

Answer 25

A. Diltiazem