Angina / angina pictoris

Question 1

Recommended treatment for angina pictoris

Answer 1

Treat risk factors

—— HTN , DM , dyslipidemia , Non pharmalogical treatment

To relief symptoms

——- 1. nitrates : sublingual nitroglycerin or nitroglycerin spray

——–2. BB -
CC ( Verapamil) or Long acting Nitrates if BB contraindicated or cannot be tolerated . if BB is unsuccessful give any of the 2 class of drug with BB

To prevent MI/Death -

• 1. ASA - 81 mg
  2. Clopiidogril of AsA contraindicated
  3. BB
  4. ACEI or ARB - Patient with HTN , DM LVEF <40% or CKD
  5. HMG COA Reductase inhibitor - STATIN

Question 2

Clinical Presentation of angina

Answer 2

precipitated by exertion
eating
exposure to cold
emotional stress
radiation of pain
are arms,
shoulders,
neck.

Question 3

Define Ischemia?

Answer 3

deficient supply of blood to a body part

Question 4

Define Angina Pectoris

Answer 4

chest pain or discomfort due to coronary heart disease

Question 5

what does PCI mean

Answer 5

Percutaneous Coronary Intervention–uses a catheter to place a small structure called a stent to open up blood vessels in the heart

Question 6

what is CABG

Answer 6

coronary artery bypass graft—- It diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen supply to the heart.

Question 7

When do we use Trimetazidine - Vasterel MR 35 mg in stable angina

Answer 7

in patients who
are inadequately controlled by or intolerant to first-line
antianginal therapies.—

Question 8

MOA of Vaterel MR

Answer 8

inhibits β-oxidation of fatty acids by
blocking long-chain 3-ketoacyl-CoA thiolase, which
enhances glucose oxidation.

Question 9

Name the drug and dose used in Chronic angina - and is reserve for
cases where other antianginals have been
inadequate

Answer 9

Ranolazine (Ranexa)–500 mg orally twice
a day

It’s a sodium Chanel blocker

Question 10

what is the consequences of using SL NTG to often

Answer 10

Pseudotolerance

Question 11

side effects of nitrates include

Answer 11

Headache & flushing
 Postural hypotension
 Dizziness
 Weakness
 Reflex tachycardia
 Drug rash

Question 12

Benefits of nitrates in angina

Answer 12

reduce after load , pre load and oxygen demand .

Question 13

what is Prinzmetal angina

Answer 13

Chest pain due to a coronary artery spasm, a sudden constriction of one of the vessels that supply the heart muscle with blood rich in oxygen. This deprives the heart muscle of blood and oxygen.

Question 14

why is BB a concern in Dabetic patients

Answer 14

BB may mask tachycardia
which is a sign that patient is developing
hypoglycemia

Question 15

what does it mean by inotropic effects

Answer 15

an abrupt increase in afterload can cause an increase in inotropy (Anrep effect). An increase in heart rate also stimulates inotropy