Angina and Myocardial infarction

Question 1

Ischaemic heart disease

Answer 1

Reduced blood supply to the heart due to insufficiency of the coronary arteries

Question 2

Angina

Answer 2

Poor oxygen supply to myocardium> chest pains

Question 3

Types of agina

Answer 3

• Stable: D>S- predictable chest pains on exertion/ mental distress
• Unstable: S>D- pains occur with less exertion
• Variant: S>D- Occurs at rest

Question 4

Acute coronary syndrome

Answer 4

heart’s blood supply is partially/ fully blocked> myocardial damage
- Includes unstable angina and myocardial infarction

Question 5

Stable angina pharmacotherapy drugs

Answer 5

Vasodilators
- Organic nitrates
- Beta-blockers
- CCB
Decrease cardiac work
- BB & CCB
Underlying atheromatous diseases
- Statins & aspirin

Question 6

Organic nitrate drugs and their MOA

Answer 6

• Glyceryl trinitrate, Isosorbide dinitrate, Isosorbide mononitrate
• Pro-drug that is metabolized to NO> NO activates guanyl cyclase to produce cGMP> cGMP dephosphorylates myosin and sequester Ca2+> vasoldilation

Question 7

Nitrate-free window in evening

Answer 7

• Thiol depleted by long-acting nitrates. Not taking in the evening allows thiol to accumulate> may potentiate ischeamia due to period of no therapeutic efficacy

Question 8

Organic nitrate contraindications and side effects

Answer 8

• 5- phosphdiesterase inhibitors> severe hypotension
• Hypotension, Headaches, reflex tachycardia

Question 9

MOA of statins

Answer 9

• Inhibits HMG-CoA reductase mediated conversion of HMG-CoA to mevalonate in liver.
• Mevalonate needed to produce cholesterl> decrease hepatic cholesterol> increases LDL-C clearance from plasma

Question 10

Statin drugs

Answer 10

Lipophilic
- Simvastatin(SA): pro-drug
- Atorvastatin(LA)
Hydrophilic
- Rosuvastatin(LA)
- Pravastatin(LA)

Question 11

Statin side effects

Answer 11

• myalgia
• GI disturbances
• Insomnia
• Angio-oedema

Question 12

Aims for unstable angina pharmacotherapy

Answer 12

• Revascularation
• Prevent re-occlusion
• Decrease cardiac work
• Prevent cardiac remodeling
• treat associated pain

Question 13

Unstable angia pharmacotherapy drugs

Answer 13

Low risk patients:
- Aspirin
- Organic nitrates, BB, CCB
Intermediate risk
- Aspirin, LMWH/UH
- Organic nitrates, BB, CCB
High risk
- ‘…’ and Clopidogrel
- Organic nitrates, BB, CCB
- Abciximab (for revascularisation)

Question 14

Pharmacotherapy for STEMI

Answer 14

• Oxygen if saturation below 94%
• Aspirin
• Organic nitrates, morphine
• Fibrinolytics

Question 15

Oygen supplementation adverse effacts that are frequent in normoxic patients

Answer 15

• Hyperoxemia
• Reduced coronary blood flow
• Free radical generation
• increase coronary vascular resistency