Angina

Question 1

Glyceryl trinitrate

Answer 1

Nitrate

Provide exogenous source of nitric oxide (which mediates vasodilator effects). Predominantly venodilators; reduce venous return and preload to the heart, reducing myocardial oxygen requirement.

Question 2

Isosorbide dinitrate

Answer 2

Nitrate

Provide exogenous source of nitric oxide (which mediates vasodilator effects). Predominantly venodilators; reduce venous return and preload to the heart, reducing myocardial oxygen requirement.

Question 3

Isosorbide mononitrate

Answer 3

Nitrate

Provide exogenous source of nitric oxide (which mediates vasodilator effects). Predominantly venodilators; reduce venous return and preload to the heart, reducing myocardial oxygen requirement.

Question 4

Ivabradine

Answer 4

Ivabradine inhibits a current regulating the interval between depolarisations of the sinoatrial (SA) node. It reduces heart rate (by about 10 beats/minute) which in turn lowers cardiac workload and myocardial oxygen demand.

Question 5

Nicorandil

Answer 5

Produces venous and arterial dilation due to its nitrate moiety and its effect on potassium channels in vascular smooth muscle; improves myocardial oxygen balance and decreases angina.

Question 6

Perhexiline

Answer 6

Unclear. It inhibits carnitine palmitoyltransferase, which may change myocyte metabolism from long-chain fatty acids to glucose, leading to improved myocardial oxygen utilisation and anti-ischaemic effects.