Anti-anginals

Question 1

Anti-platelet agents to treat/prevent angina?

Answer 1

e.g, Aspirin, P2Y12 inh., GPIIB/IIIa inh.

Prevention of arterial thrombosis.

Question 2

MOA of nitrates to treat angina?

Answer 2

Nitrates=> NO=> Activates Guanylyl Cyclase=> increases cGMP=> Activates protein kinases=> Phophorylates myosin light chains=> Decreases IC Ca2+=> Vascular relaxation.

Question 3

What do nitrates treat?

Answer 3

• SA
• UA
• MI
• Hypertension
• HF

Question 4

SE’s of Nitrates?

Answer 4

Headache
Hypotension
Interact with Phosphodiesterase 5 inhibitors. (e.g Viagra)= Extreme hpotension.

Question 5

B blockers in treating Angina?

Answer 5

Block effects of adrenaline on B adrenoreceptors.
Decrease HR, Contractility and Afterload.
e.g Metoprolol, Atenolol (Cardioselective)
Propranolol, Timolol (Non-selective)
Carvedilol (Alpha 1 antagonist)

Question 6

Uses of BB’s?

Answer 6

• SA
• UA
• MI
• HF
• Arrhythmias

Question 7

SE’s of BB’s?

Answer 7

Bronchoconstriction: block beta-2 mediated smooth muscle relaxation in the bronchi. Thus relatively contra-indicated in reversible airways disease eg asthma
Mask symptoms of hypogylcaemia
May precipitate heart failure
Bradycardia
Exacerbate peripheral vascular disease
Somnolence, Depression
Impotence
Adversely alter lipid profile

Question 8

MOA of Ca2+ channel blockers to treat angina?

Answer 8

Block L type Ca2+ channels, decrease IC Ca2+, decrease contractility, HR, afterload and relax vasc smooth muscle.
Therefore decreases work on the heart.

Dihydropyridines predominately affect vasculature (lower bp) e.g Amlodipine, Nifedipine.
Non-dihydropyridines predominately affect the heart (lower HR) e.g, Verapramil, Diltiazem.

Question 9

What do CCB’s treat?

Answer 9

SA
Arrhythmias
Hypertension

Question 10

SE’s of CCBs?

Answer 10

Dizzyness
Flushing
Hypotension
Peripheral oedema/ankle swelling
Bradycardia
Constipation.
 Precipitate heart failure