14. DSA Drugs Used in Chronic IHD

Question 1

All of the following are what type of drug used in IHD?
Nitroglycerin
Isosorbide Dinitrate
Isosorbide Mononitrate

Answer 1

Nitrates (nitrovasodilators)

Question 2

All of the follow are what type of drug used in IHD?
Amlodipine
Nifedipine
Nicardipine

Answer 2

Non cardioactive calcium channel blockers CCBs

Question 3

All of the follow are what type of drug used in IHD?
Diltiazem
Vernapamil

Answer 3

Cardioactive calicum channel blockers

Question 4

All of the follow are what type of drug used in IHD?
Propranolol
Nadolol
Metoprolol
Atenolol

Answer 4

Beta-Blockers

Question 5

What is the main difference between stable angina (classic) and variant (prinzmetal) angina?

Answer 5

Classic you have pain during exercise and stress

Variant symptoms occur at rest d/t vasospasm of the coronary A

Question 6

Vasodilators are most useful in which type of angina?

Answer 6

Prinzmetal/Variant angina (NOT useful in classic angina)

Question 7

To treat angina, you must reduce myocardial oxygen demand by decreasing HR, preload, afterload, and contractility. how do endothelial cells produce NO?

Answer 7

NOS via Arginine makes NO which goes to smooth muscle cells and cause relaxation via cGMP/PKG

Question 8

Nitrates are metabolically activated to form NO in endothelial cells, which activates guanylyl cyclase, activating cGMP, leading to PKC which causes hyperpolarization and reduced calcium entry and?

Answer 8

Myosin LC dephospharylation = smooth muscle relaxation

Question 9

Nitrates have a significant first pass metabolism- highly reduced in the liver. Which of the 3 has a higher bioavailbility orally (even though all are low)?

Answer 9

Isosorbide Mononitrate

Question 10

What is needed to release NO from nitrates?

Answer 10

Thiol compounds (nitrates affect veins> large arteries > small arteries and arterioles)

Question 11

NItrates cause vasodilation of smooth muscle = increase venous capacitance and reduced preload. Dilation of A at higher doses may lead to?

Answer 11

reducing afterload

Question 12

What is the main effect of reducing preload for treating angina symptoms?

Answer 12

decreasing O2 demand

Question 13

Short acting nitrates are used to relieve a current angina attack in the form of sublingual spray (not mononitrate). What about long acting nitrates?

Answer 13

To prevent aginal attacks in the future

Question 14

What is a huge drug interaction of nitrates?

Answer 14

with Sildenafil/Vardenafil/Tadalafil (PDE5 inhibitors) causses extremely low BP

Question 15

Calcium channel blockers block Ca from entering cells via the voltage dependent Ca channel which causes?

Answer 15

a lack of smooth muscle contraction

Question 16

Cardioactive caclium channel blockers differ mechanistically from noncardiactive in what way?

Answer 16

Dihydropyridines (non cardioactive) have highest affect on vasodilation and next to none on the heart
Cardioactive has less vasodilation and more decrease in heart contractility, automaticity and conduction

Question 17

Calcium channel blockers decrease myocardial O2 demand operating well in classic angina and also increase blood supply to the heart, operating well in?

Answer 17

variant angina (dilation of coronary A relieves local spasm)

Question 18

What is the main way to treat variant angina?

Answer 18

CCBs are first choice

Low acting Nitrates after

Question 19

What is the main way to treat stable angina?

Answer 19

Beta blocker/CCB
Add CCB or BB
Add low acting nitrates
CABG surgery