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Angina Flashcards

1
Q

Chest pain due to transient myocardial ischaemia

A

Angina pectoris

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2
Q

Cardiac work

A

Oxygen needs

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3
Q

Coronary flow

A

Oxygen supply

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4
Q

Determinants of demand

A

Heart rate
Systolic
Myocardial wall stress/tension (determined by systolic)
Contractility

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5
Q

Determinants of supply

A

Coronary artery diameter
Collateral blood flow
Perfusion pressure (subendocardial before subepi)
Heart rate

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6
Q

Angina of effort - on exertion

A

Atherosclerosis
Decrease cardiac work

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7
Q

Unstable(crescendo or pre infarction) - mild exertion

A

Occlusion on top of atherosclerosis (the plaques broke)
Hospitalisation VD decrease cardiac work and antithrombotic

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8
Q

Variant - at rest

A

Reversible coronary VC
Coronary VD treatment

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9
Q

Angina drugs never given on their own - adjuvants
All of them:

A

Anti angina
-VDs and drugs that decrease cardiac work like nitrates and CCB
-only decrease cardiac work like BB
-others
Adjuvant drugs

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10
Q

The others

A

Nicorandil - nitroD(release NO) and k channel opener
Trimetazidine
Ranolazine
IvaBRAdine - bradycardia

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11
Q

Adjuvant

A

Anti platelet - aspirin, clopidogrel, ticlopidine
Treatment of risk and precipitating factors - anti hypertensive, hyperlipidemi, diabetic, anxiety

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12
Q

Isosrbid dinitrate

A

Has a slower onset and greater duration of action than mononitrate

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13
Q

All organic nitrates jndergo extensive and variable first pass with only 10%bioavailability except for

A

Isosorbid mononitrate
Anyways SR tabs for the rest

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14
Q

Nitrates are denitrated by

A

Glutathione transferase (consumes SHmeaning SH dependent?)

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15
Q

Nitrates act by

A

2 Mechanisms: calcium and MLCK dephosphorylation while B blockers act through 1

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16
Q

Nitrates inhibit

A

Platelet aggregation

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17
Q

Pharmacology

A

BV heart hypotension spasmolytic RC

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18
Q

Nitrates act on veins because

A

They expressed greater amount of enzyme than arteries

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19
Q

Veno d

A

Nitrates: decreased vr edv and preload

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20
Q

Arterio d

A

Nitrates: decreased TPR decreasing afterload

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21
Q

Meningeal VD

A

Headache

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22
Q

Cutaneous VD

A

Flushing and nitroid reaction

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23
Q

Pulmonary VD

A

VR and pulmonary presdure

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24
Q

Decreased pressure on subednocardial coronaries

A

Decreases Contractility

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25
Short acting sl or buccal apray
Acute or prodrome GTN Isosorbid
26
Long acting chronic
GTN - SR transdermal delivery Iso Di - tablets or SR Iso mono - tabkwbs⁷
27
GTN (IV) limits the area of necrosis in MI...
By fabourably altering oxygen balance in the marginally partially ischaemic zone
28
Congestive heart failure reduction
Because NO (IV) reduce preload and receive pulmonary congestion shifting blood to systemic circulation
29
Continuous gemodynamic changes
To monitor changes after IV TmGTN infusion for congestive heart failure
30
Morphine causing biliary colic
Treat with GTN or isisorbide dinitrate
31
Sodium nitrite
The nitrate you take IV to generate enough methemoglobin in cyanide poisoning without hypotension
32
Tadalafil and sildenafile
Phosphodiesterase inhibitors so VDs
33
CCBs
Dihydropyridine Non - dihydropyridine
34
Dihydropyridine VD Dipine family: amlodipine, nifedipine *specific to bv causing VD, nitrendipine, felodipine, isradipine, nicardipine and nomodipine
Long acting- amlodipine Intermediate- FINN Short- Nicardopine nimodipine
35
Non dihydropyridine
Verapamil (arrhythmia) and diltiazem -specific to heart causing inhibition more than effects on bvs
36
-ve chronotropy
Inhibit SAN so bradycardia and prolonged diastolic so antagonises tachycardia you get from nitrates
37
-ve inotropy
Decreased cardiac work and oxygen consumption
38
-ve dromo
Decreases AV node consumption So contraindicated in heart block
39
Not combined with beta blockers or digitalis
Nodihydros (plus class 4 antiarrhythmics) because -ve dromo
40
Hypotension too from reflex stimulation
Nifedipine (bv moes than heart)
41
Potent coronary VD but less peripheral VD with less hypotension than nifedipine
Nodihydros
42
Potent arterio but weak veno D so less after load than preload decrease
Nifedipine
43
Steal phenomenon (where small coronaries steal from the ischaemia site
Nifedipine
44
Dihydros don't inhibit AVN so...
Allowed in heart blocks
45
Dihydros have minimal -ve intoropy (affects afterload and preload so minimal)
So allowed in heart failure
46
In Hypertrophic obstructive cardiomyopathy
No dihydros
47
Alternative fo premature labour
Nifedipine (plus hypertension)
48
Migraine prophylaxis CCB
Nimodipine(bbb so CNS) and flunarizine
49
Adverse effect of verapamil
Constipation
50
Ankle oedema
Adverse effect of nifedipine
51
Verapamil lobes drugs that aggrevate heartblock(-ve dromotropy like itself)...
Decreased renal excretion of dioxin With beta blockers causes severe cardiac depression(heart block)
52
Nifedipine and nitrates no go
Both cause hypotension and then reflex tachycardia
53
Indapmide
Subdueretic dose of thiazide in treatment of hypertension
54
Nifedipine and indapamide(minimal effects on electrolyte and metabolites) allowed in renal patients
As undergo biliary excretion
55
Beta blockers used *Those without ISA
Non selective - propranolol nadolol Selective beta 1 - metoprolol atenolol bisoprolol Vaso Ds - carvedilol
56
Beta blockers don't cause Vaso d (they only block heart) but
There's nothing wrong with subendocarfial flow as there's favourable redistribution (non selective block beta2 as well so VC) and decrease in ventricular wall tension
57
Contraindicated in variant angina
Beta blockers
58
Never abruptly discontinued Like nitrates
Beta blocker
59
CCBd and nitrates decrease ischaemia by
Increasing total coronary flow and distribution of flow to ischaemic sites Increase subendocardial Perfusion by dilating collaterals and decrease intraventricular pressure and resistance
60
Improve coronary dustribution
Beta blockers through reducing intraventricular pressure
61
Anything(not hydropyridines) with beta blocker
Preventing tachycardia and increasing diastolic coronary perfusion
62
Antiplatelets
Aspirin SD inhibit TXA2 ADP receptor blockers - Ticlodipine and Clopidogrel GP 1b and 3a receptor blockers - abxiximab and tirofiban
63
Nicoradil orally for angina and HF
Dual mechanism of action
64
Trimetazidine (orally add on) pFOX attached acid oxidation pathway inhibitor
Shifts from fatty acids to glucose during ischaemia decreasing lactate and oxygen demand
65
Ranolazine
Inhibits late Na decreasing Ca -Decreases Contractility -Decreases oxygen demand
66
Ivabradine for chronic stable angina
Taken With beta blockers Normal sinus rhythm HR 70 and above
67
Ivabradine
BradyC through inhibition of pacemakers for normal spontaneous diastolic depolarization

Pharmacology (25 decks)

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