Angina Flashcards
What is stable angina?
Chest Pain that comes on predictably on exertion and dissipates at rest
What are the big 5 CVD risks?
Smoking High BP FH Cholesterol Diabetes
What are the the therapeutic objectives for Angina?
Amelioration of anginal symptoms and improved angina-free exertion capacity
Prevention of subsequent acute MI
How can the work the heart has to do, be relieved?
Reduce - Pre-load Afterload Contractility Heart rate
What drug classes are used in the treatment of angina?
Nitrates
Calcium Channel Blockers
Beta Blockers
What do Beta Blockers reduce?
Contractility and Rate majorly
Preload and Afterload are affected to a lesser degree via the renin-angiotensin system by reducing angiotensin II and thus vasoconstriction
Where to beta blockers work?
Block beta 1 receptors in the heart
What does vasoconstriction reduce?
Increases Afterload
What do CCB’s do?
Block L-type calcium channels
What are the two types pf CCB?
dihydropyridine - more effective on vessels impact BP greatly
non-dihydropyridine - more effective on heart
Which type pf CCB is more useful in treating angina?
Non-dihydropyridine
How doe nitrates work?
Atherosclerotic vessels’ endotheilum does not produce NO
Nitrates will dilates coronary vessels
Reducing afterload and preload
Both arterial and venous systems are dilated
What is used in the short-term treatment on angina?
GTN manages acute attacks
Also used for prophylaxis
What is used in the long-term treatment on angina?
Beta Blockers
Why is GTN preferred for acute attacks?
Sublingual administration allows for faster drug delivery
Betablockers are all oral tablets
What are the cautions for when using GTN?
Tolerance
Can be reduced by leaving gaps between doses
What is the mechanism behind the development of tolerance?
Vascular tolerance
Impaired GTN biotransformation
Increased vascular superoxide production
Desensitisation of soluble guanylate cyclase
Increases in phoshopdiesterase activity
Increases sensitivity to vasoconstrictors
Increased endothelin expression
What are the three most commonly prescribed beta blockers in this area?
Bisprolol
Atenolol
Propranolol
What are the adults does for the three beta blockers?
Bisoprolol - 5–10 mg once daily; maximum 20 mg per day.
Atenolol –.100mg daily in 1-2 divided doses.
Propranolol - Initially 40 mg 2–3 times a day; maintenance 120–240 mg daily
What are the differences in dosing strategy for bisprolol for angina and heart failure?
Angina is 5-20mg but the LOWEST dose that works - resolving a symptom and tying to reduce morbidity
Heart Failure is 1.25-10mg at the HIGHEST dose the patient can tolerate since in heart failure you aren’t treating a symptoms but trying to reduce mortality
What age related changes decrease drug effectiveness?
Decreased GI blood flow
Decreased plasma proteins
Decreased cardiac beta-adrenoreceptors
What age related changes increase drug effectiveness?
Decreased liver enzymes
Decreased renal blood flow
