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Chronic stable angina > Angina drugs > Flashcards

Angina drugs Flashcards

1
Q

What conditions does an ACS involve?

A

Unstable angina.
Non-ST elevation MI.
ST elevation MI.

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2
Q

What is the initial treatment for an ACS?

A

M - morphine.
O - oxygen.
N - nitrates.
A - anti-platelet (aspirin or clopidogrel).

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3
Q

What is the preventative treatment for an ACS?

A 
MI-5:
> Aspirin.
> Clopidogrel.
> ACEi.
> Beta blockers.
> Statin.
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4
Q

What is the MOA of nitrates?

A

Release NO > increased cGMP > smooth muscle relaxation.

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5
Q

Give some examples of nitrates?

A 
GTN.
Isosorbide mononitrate (long acting).
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6
Q

What are the side effects of nitrates?

A

Headaches.
Hypotension.
Flushing.

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7
Q

When are nitrates contra-indicated?

A

Hypotension.
Mitral & aortic stenosis.
Hypertrophic cardiomyopathy.

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8
Q

Give examples of anti-platelet drugs?

A

Aspirin.
Clopidogrel.
Prasugrel.
Ticagrelor.

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9
Q

What is the MOA of aspirin?

A

Irreversibly inhibits COX > inhibition of TXA2.

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10
Q

What are the side effects of aspirin?

A

GI irritation.

Bronchospasms.

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11
Q

When is aspirin contra-indicated?

A

PUD & bleeding disorders.

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12
Q

What is the MOA of clopidogrel?

A

Pro-drug converted to an active drug by P450 enzymes.

Blocks P2Y12 adenosine receptors on platelets > inhibits aggregation.

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13
Q

What are the side effects of clopidogrel?

A

GI irritation.

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14
Q

What are the contra-indications for clopidogrel?

A

Active bleeding.

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15
Q

What interactions does clopidogrel have?

A 
Enzyme inducers (i.e. omeperazole) reduce anti-platelet activity.
Fluoxetine reduces anti-platelet effect.
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16
Q

Give examples of ACEi?

A

Ramipril.

Captopril (short acting).

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17
Q

What are the MOA of ACEi?

A

Inhibits ACE (converts angiotensin I > angiotensin II).

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18
Q

What are the side effects of ACEi?

A

Dry cough.
Hypotension.
Hyperkalaemia.
Renal & hepatic impairment.

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19
Q

What do ACEi interact with?

A

ACEi + diuretics > rapid hypotension.

20
Q

Give examples of angiotensin II receptor blockers?

A

Losartan.

21
Q

When would you give an angiotensin II receptor blockers?

A

If patients can not tolerate ACEi due to dry cough.

22
Q

Give examples of beta blockers?

A

Bisoprolol (B1 anatagonist).

Metoprolol (short acting).

23
Q

What is the MOA of beta blockers?

A

Beta adrenergic antagonist > decreased HR & contractility.

24
Q

What are the side effects of beta blockers?

A

Bronchospasm.
Bradycardia.
Cold extremities.

25
Q

What are the interactions of beta blockers?

A

Risk of AV block if used with diltiazem/verapamil.

26
Q

Give examples of statins?

A

Simvastatin.

27
Q

What is the MOA of statins?

A

Inhibit HMG CoA reductase > decreased LDL.

28
Q

What are the side effects of statins?

A

Altered liver function.
Myalgia.
Rhabdomyolysis.

29
Q

What interacts with statins?

A

Grapefruit juice.

30
Q

Give examples of dihydropyridines?

A

Amlodipine.

Nifedipine.

31
Q

What is the MOA of dihydropyridines?

A

Inhibits Ca2+ influx > smooth muscle relaxation.

32
Q

What are the contra-indications of dihydropyridines?

A

Uncontrolled heart failure.
Within 1 month of a MI.
Aortic stenosis.

33
Q

Gives examples of non-dihydropyridines?

A

Verapamil.

Diltiazem.

34
Q

What is the MOA of non-dihydropyridines?

A

Inhibit Ca2+ influx > smooth muscle relaxation.

Slows conduction rate at the AV node.

35
Q

What are the side effects of non-dihydropyridines?

A

Bradycardia.

SA/AV block.

36
Q

When are non-dihydropyridines contra-indicated?

A

Bradycardia.

Heart block.

37
Q

Give an example of a K+ channel activator?

A

Nicorandil.

38
Q

What is the MOA of nicorandil?

A

NO donor > increased cGMP > smooth muscle relaxation.

Open K+ channels > hyperpolarisation > inhibition of voltage gated Ca2+ channels > smooth muscle relaxation.

39
Q

When is ivabridine used?

A

As a 3rd line treatment or if beta blockers are contra-indicated.

40
Q

What is the MOA of ivabridine?

A

Blocks Na+ funny channels > decreased rate of SA firing.

41
Q

When is the use of nicorandil contra-indicated?

A

LV failure.

42
Q

What are the side effects of ivabridine?

A

Visual disturbances.
1st degree heart block.
Bradycardia.

43
Q

When is the use of ivabridine contra-indicated?

A

Bradycardia.
Acute MI/CVA.
2nd/3rd degree heart block.
Unstable/acute CCF.

44
Q

When is ranolazine used?

A

Cardiologists only - to treat patients who remain symptomatic despite optimal treatment.

45
Q

What is the MOA of ranolazine?

A

Inhibit late Na+ channels > decreased Ca2+ overload > smooth muscle relaxation.

46
Q

When is the use of ranolazine contra-indicated?

A

Hepatic impairment.
CCF & QT elongation.
Elderly & low body weight - < 60kg.

Chronic stable angina (1 decks)

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