Angina

Question 1

What is angina?

Answer 1

= occurs when myocardial oxygen demand exceeds supply (myocaridal ischaemia)

Question 2

Stable angina

Answer 2

= Blood supply (& oxygen) is reduced because of atherosclerotic changes in coronary arteries

- Treatment aimed at reducing myocardial oxygen demand, increasing oxygen delivery and preventing plaque progression  and 	thrombotic complications
- Anginal pain usually subsides with rest and increases with physical activity or emotion 
	- may radiate to jaw, neck or arm

Question 3

What is the treatment for stable Angina?

Answer 3

• Organic nitrates
• Calcium channel blockers
• beta blockers

Question 4

Treatment of underlying conditions with stable angina?

Answer 4

• antiplatelet medication e.g. low dose aspirin
• blood pressure control e.g. ACE inhibitor
• Lipid control e.g HMC-COA Statins

Question 5

MOA of organic nitrates?

Answer 5

= metabolise to nitric oxide

• increase cGMP levels
• produce smooth muscle relaxation

Question 6

How is treatment of angina effective causes

Answer 6

• venous dilation —> reduces venous return and preload which reduces cardiac work and oxygen demand
  
  • Artery dilation —> reduces peripheral resistance and after load which reduces cardiac work and oxygen demand
  • Dilate coronary vessels and increase coronary blood flow, increases myocardial oxygen supple

Question 7

Examples of organic nitrates

Answer 7

• glyceryl nitrate
• isosorbide monoitrate
• isosorbide dinitrate

Question 8

Adverse reactions of organic nitrates?

Answer 8

• postural hypertension
• dizziness
• headache
• contact dermititis

Question 9

Contradictions

Answer 9

Tolerance - too frequent and continuous use = tolerance which decreases therapeutic effect