A-25. Drugs used for treatment of angina pectoris. Pharmacotherapy of ischemic heart disease.

Question 1

Please review nitrates, beta blockers, and calcium channel blockers for treatment of angina pectoris

Answer 1

Please review nitrates, beta blockers, and calcium channel blockers for treatment of angina pectoris

Question 2

Drug classes for treatment of stable coronary heart disease

Answer 2

• beta-blockers
• thrombocyte aggregator inhibitors
• antihyperlipidemic treatment
• ACE inhibitor or ARBs
• Nitroglycerine
• Calcium channel blocker
• Cytoprotective drugs

Question 3

Antiplatelet treatment drugs

Answer 3

1. ) Thrombin inhibitor
   - Dabigatran
2. ) P2Y12 inhibitor
   - Ticlopidine
   - Clopidogrel
   - Prasugrel
   - Ticagrelor
3. ) COX-1 inhibitor
   - Aspirin
4. ) GPIIb/IIIA antagonist
   - abciximab
   - eptifibatide
   - tirofiban

Question 4

Do COX2 inhibitors and Acetaminophen have antiplatelet activity

Answer 4

No

Question 5

For using of Clopidogrel, which patients are at higher risk o f subsequent cardiovascular event

Answer 5

CYP2C19 loss of function allele

Question 6

Four things that change lipid profile

Answer 6

1. ) lifestyle changes i.e. exercise
2. ) Diet (omega-3 are not effective for preventing future heart and stroke in patients who had previous heart attack)
3. ) Estrogen
4. ) Drugs
   - ACE inhibitors- amelioration o fendothelial dysfunction
   - Drugs decreasing the lipid levels of the blood

Question 7

Which are the major antihyperlipidemic drugs? Which is used most typically in ischemic heart disease

Answer 7

Statins- most often used
Fibrates- most often used
Ezetimibe- used also
PCSK9- used also
Resin
Niacin

Question 8

Statin sides effects?

Answer 8

Rhabdomyolysis, myopathy

Question 9

Statin intolerance

Answer 9

myalgia and increased CK biomarkers

Question 10

What to change in statin intolerance

Answer 10

• other statin
• dose reduction
• lose dose statin in combo with ezetimbe
• discontinuation of statins ((ezetimibe, PCSK9)

Question 11

What do Nitrates do in ischemic heart disease

Answer 11

They increase venular dilation decreasing preload on heart and dilate the coronaries

Question 12

What do ACE inhibitors do in IHD

Answer 12

They increase venular and arterolar dilation which decreases preload and afterload

Question 13

What do CCB do in IHD

Answer 13

They increase arteriolar dilation decreasing afterload on the heart and dilate the coronaries

Question 14

What do Beta blockers do in IHD

Answer 14

They decrease O2 demand, cardiac work, wall tension, and pain

Question 15

What to give for pain and sympathetic tone increased in IHD

Answer 15

oxygen, pain reliever (iv opiods), tranquilizer (benzodiazapines)

Question 16

Which drug shifts cardiac metabolism to glucose oxidation from fatty acid oxidation

Answer 16

Trimetazidine

Question 17

Why is it important to shift to glucose oxidation iwth trimetazidine?

Answer 17

Delays uncoupling of mitochondrial respiratory chain. This…
-Inhibits the production of reactive free radicals
-Maintains ATP production
Delays the onset of Anaerobe glycolysis which decreases intracellular acidosis

Question 18

Kinetics of trimetazidine

Answer 18

• fast oral absorptions
• half life- 4-5 hours
• excretion in the kidneys

Question 19

New antianginal agent similar in structure to nitrates

Answer 19

Molsidomine that leads to SIN-1 then 2 to form NO

Question 20

Which cytoprotective drug inhibits late sodium channels in myocardial cells

Answer 20

Ranolazine

Question 21

MOA of Ranolazine

Answer 21

1. ) Inhibits late sodium channels in myocardial cells. This decreases intracellular Na, thereby activating Na/Ca transporter and decreases intracellular Ca overload
2. ) Decreases fatty acid oxidation in the myocardium
3. ) Decreases cardiac work, cytoprotective

Question 22

Which new drug is used in both stabile effort angina and heart failure

Answer 22

Ivabradin

Question 23

MOA of Ivabradin

Answer 23

decreases activity of sinus node by reducing the pacemaker If current
This decreases the heart rate without modifying the electric conduction parameters and contractile force

Question 24

Contraindication of Ivabradin

Answer 24

sick sinus syndrome

Question 25

Vitamins used to treat IHD

Answer 25

Omega 3, EPA, DHA—> decrease serum triglyceride levels and the formation of atherosclerotic plaques
Coenzyme Q10 (ubiquinon —> antioxidant, ATP production (in heart failure)
B6 and B12, folic acid—> decrease serum homocysteine level