Angina

Question 1

Overall aim of pharmacological treatments for angina

Answer 1

To restore the imbalance between myocardial oxygen supply and demand.

Question 2

In an early AMI, pharmacological treatment is used to

Answer 2

Restore myocardial oxygen supply

Question 3

Most medicines given for the chronic management of CHD reduce

Answer 3

Myocardial oxygen demand

Question 4

In acute care settings, oxygen is administered and titrated to

Answer 4

Augment PaO2 and SaO2 and optimise oxygen delivery to the myocardium (GTN, aspirin, morphine)

Question 5

The top ten treatment elements for angina include:

Answer 5

Aspirin and anti-anginas therapy; beta-adrenergic blocker and blood pressure (ACEI); cigarette smoking and cholesterols diet and diabetes; education and exercise

Question 6

Aspirin is used for

Answer 6

Prophylaxis

Question 7

Aspirin doses

Answer 7

75-150mg per day

Question 8

Aspirin works by

Answer 8

Inhibiting platelet aggregation by irreversibly inhibiting cyclo-oxygenase reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation)

Question 9

AEs of aspirin

Answer 9

GI irritation, asymptomatic blood loss and increased bleeding time

Question 10

Anti-anginal therapy includes

Answer 10

GTN, isosorbide dinitrate and isosorbide mononitrate

Question 11

Anti-anginal: dosage for sublingual tablets

Answer 11

300-600mcg every 3-4 minutes, until pain is resolved to a max of 1800mcg- if no relief, call help/ambulance

Question 12

Anti-anginal: dosage for lingual aerosol

Answer 12

400-800mcg, repeat after 5 mins. If necessary, to a max of 3 sprays

Question 13

Anti-anginal: use for transdermal patch

Answer 13

For sustained release; angina prophylaxis

Question 14

AEs of anti-anginals

Answer 14

Dizziness, headache, hypotension, flushing, tachycardia, palpitations, orthostatic hypotension, fainting and peripheral oedema.
Concurrent alcohol use may also enhance orthostatic hypotension

Question 15

Cardio-selective beta blockers can

Answer 15

Reduce frequency of angina and prolong exercise capacity as well as decrease the risk of adverse cardiac events and mortality

Question 16

E.g. of cardio-selective beta-blockers

Answer 16

Atenolol (25-100mg/day) and metoprolol (50-300mg/day)

Question 17

How do cardio-selective beta-blockers work

Answer 17

By competitively blocking beta-receptors in the heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver

Question 18

What do cardio-selective beta-blockers do

Answer 18

Decreases HR, alter conduction velocity, myocardial contractility and decrease CO

Question 19

Common AEs of cardio-selective beta-blockers

Answer 19

Bradycardia, hypotension, orthostatic hypotension, transient worsening of heart failure, nausea, diarrhoea, bronchospasm, dyspnoea, cold extremities, exacerbation of Raynaud’s phenomenon, fatigue, dizziness, abnormal vision, alteration of glucose and lipid metabolism

Question 20

BP controlled with

Answer 20

ACE inhibitors/second generation AT1 receptor blockers prevent remodelling and reduce mortality following an AMI

Question 21

E.g. of ACE inhibitors

Answer 21

Captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril

Question 22

What do ACE inhibitors do

Answer 22

They block conversion of angiotensin I to angiotensin II and inhibit the breakdown of bradykinin. Reduce vasoconstriction, sodium retention and aldosterone release

Question 23

AEs of ACEI

Answer 23

Hypotension, headache, dizziness, cough, hyperkalaemia, fatigue, nausea and renal impairment

Question 24

Cigarette smoking treatment

Answer 24

Can be used in conjunction with nicotine replacement therapy and other treatments.
5As framework for smoking cessation- well recognised behavioural strategy for addiction.

Question 25

Treatment for cholesterol

Answer 25

Stains are the first line in lipid-lowering treatment (apart from diet) for the reduction of CVD risk

Question 26

E.g. of statins

Answer 26

Atorvastatin, rosuvastatin, simvastatin

Question 27

Diet and diabetes treatment

Answer 27

Reduce intake of saturated and trans fats.
Replace saturated fats with monounsaturated and polyunsaturated fats, increasing intake of soluble fibre.
Introduce plant sterol and enriched milk, margarine or cheese products.
The most effective dietary measure and can reduce LDL-C.
Excess body weight is associated with many major risk factors for CVD including T2DM, elevated BP and dyslipidaemia.

Question 28

Implementing education and exercise

Answer 28

Regular physical activity has a beneficial effect on multiple CV risk factors as well as a significant mortality benefit.
Should be strongly encouraged in patients, for both prevention and management of CV disease.