B - 20. Drugs used for treatment of angina pectoris. Pharmacotherapy of ischemic heart disease.

Question 1

Types of angina

Answer 1

Effort angina, unstable angina, Prinzmetal angina

Question 2

Nitrates: names

Answer 2

Nitroglycerine

isosorbid-mononitrate

Question 3

pFOX inhibitors (partial fatty
acid oxidation inhibitors): names

Answer 3

trimetazidine

Question 4

Rate inhibitors:

Answer 4

ivabradin

Question 5

All drug classes used to treat:

Answer 5

First line: B-blockers

Second line:

• nitrates
• Ca++ chn blockers
• pFOX inhibitors
• Rate inhibitors

Question 6

Nitrates: action

Answer 6

Nitrates release nitric oxide in smooth muscle cells. NO activates guanylyl cyclase → cGMP ↑ →
dephosphorylation of myosin light chain ↓ → smooth muscle relaxes (identical mechanism to nitroprusside)

Question 7

pFOX inhibitors (partial fatty
acid oxidation inhibitors): action

Answer 7

reduces fatty acid oxidation, but more importantly reduces sodium current in myocardial cells.

• decrease in intracellular Na → increased Ca2+ excretion via Na/Ca transporter → decreased contractility
• moderately effective in angina prophylaxis

Question 8

Rate inhibitor: action

Answer 8

Ivabradine: inhibits funny channels in SA node → hyperpolarization of pacemaker current → HR ↓ →
workload ↓