Angina

Question 1

What is angina pectoris

Answer 1

pain down left chest/arm from ischaemic chest pain, imbalance between o2 demand + supply

Question 2

Drugs types used to treat

Answer 2

Nitrates/nitrites
Ca antagonists
Beta-blockers

Question 3

Determinants of myocardial o2 consumption

Answer 3

HR
Contractility
Wall stress (pressure inside heart)

Question 4

Nitrites/nitrates MOA

Answer 4

Amyl nitrite (poppers)/ GTN, isosorbide mono(/di)nitrate (longer acting than GTN) are denitrated and causes smooth muscle relaxation, dilates large veins first (pre-load) then arteriolar vasodilation and dilates collateral coronary vessels so redistribution of coronary flow to ischaemic areas

Question 5

Nitrates/nitrites SE

Answer 5

arteriolar: flushing, headaches, BP drop, postural hypotension, but only venous effects in small doses
Reflex tachycardia, inc collateral flow in angina patients, inc coronary flow in normal

Question 6

beta-blockers MOA

Answer 6

bisoprolol reduces HR, contractility and BP so lower O2 demand, decreased HR means more time in diastole so more perfusion and filling, coadministered with nitrate

Question 7

Ca antagonists MOA

Answer 7

Verapimil (more for heart), Nifedipine/amlodipine (vessels), diltiazem, reduce after-load and contractility, slow conduction, and cause CA dilation

Question 8

Ca antagonist SE

Answer 8

Headache, constipation with verapamil, bradycardia/high degree AV block

Question 9

Ivabradine MOA

Answer 9

Inhibits funny ion current (mixed inwards Na/K activated by hyperpolarisation), increases diastole so more perfusion

Question 10

Nicorandil MOA

Answer 10

K channel activator, hyperpolarises smooth muscle so dilated

Question 11

Drugs used in addition to improve CA disease prognosis

Answer 11

Anti-platelets (aspirin, tirofiban + abciximab (glycoprotein IIb/IIIa inhibitor), heparins)
Statins