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Medicine 2 Weeks 1 - 6 > Cardiovascular Therapeutics > Flashcards

Cardiovascular Therapeutics Flashcards

1
Q

IHD

A

Ischaemic Heart Disease

Angina or MI

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2
Q

Greatest risk factor for chronic heart failure

A

IHD as the cardiomyocytes become dysfunctional

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3
Q

Risk factors for developing heart disease

A 
Male Gender
Family History
Ethinicity
Smoking - Most important
Diabetes
Hypercholesterolaemia
Hypertension
Sedentary Lifestyle
Obesity
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4
Q

Stable Angina

A

Atherosclerosis in coronary artery, limiting heart’s ability to respond to increased demand

Symptoms on exertion but relieved by rest

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5
Q

Unstable Angina

A

Plaque rupture and formation of a non-occlusive thromboembolism or vasospasm

Symptoms at rest

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6
Q

ECG Diagnosis of Angina

A

ST-Depression

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7
Q

Angiography

A

Needed for definitive diagnosis of angina

Insert catheter into radial artery and advance it up into coronary circulation
Insert radio-opaque dye and X-ray heart

This would show the narrowing seen in IHD

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8
Q

Management of Angina

A

Lifestyle

  • Stop smoking
  • Exercise
  • Diet
  • Weight

Coronary artery bypass grafting

Angioplasty & Stenting

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9
Q

PTCA

A

Percutaneous Transluminal Coronary Angioplasty

Angioplasty with a stent

Primary treatment of heart attack in the UK

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10
Q

STEMI

A

ST Elevation Myocardial Infarction

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11
Q

GTN

A

Glyceryl Trinitrate (Drug to treat angina)

Releases NO in blood, leading to vasodilation as it activates guanylyl cyclase and releases cGMP

Major effect is venodilation that reduces pre-load, reducing work on heart and thus angina symptoms

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12
Q

Delivery of GTNs

A

As a spray under the tonguethat either prevents attacks or can relieve one

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13
Q

Risk of oral Nitrates

A

Prolonged exposure can reduce effectiveness; tolerance is developed

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14
Q

How to clinically overcome nitrate tolerance

A

Aim for a nitrate free period; 2 doses rather than 3 per day

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15
Q

Beta-blockers

A

Selective B1 Adrenoceptor blockers

First choice drugs for prevention of IHD

Negative Inotropic and chronotropic effects reducing cardiac work and preventing symptoms

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16
Q

When does coronary flow occur and how do beta-blockers affect this

A

Coronary flow only occurs during diastole

By slowing the heart, the diastolic period will be increased, as will the time for coronary blood flow

17
Q

General effects of Beta-Blockers

A

Anti-arrhythmic effects and reduce the risk of myocardial infarction.

18
Q

Calcium channel blockers

A

Vasodilators and improve coronary blood flow, so prevent symptoms of IHD

19
Q

Types of Calcium Channel Blockers with example

A

Rate-limiting Agents (e.g. Verapamil)

Dihydropyridines (e.g. Amlodipine)

20
Q

Rate Limiting Agents Ca2+ Channel Blockers

A

Act on the heart and have myocardial depressant actions

- Used as a substitute for beta-blockers in AFib as they have a similar effect

21
Q

Dihydropyridines

A

Selective Ca2+ channel blockers that are selective for vascular smooth muscle and lead to vasodilatation

22
Q

Ace Inhibitors

A

Reduces mortality of patients with IHD

23
Q

Potassium Channel Activators

A

Nicorandil - combined NO donor and activator of ATP sensitive K-Channels

Opens K+ channels, letting K+ leave cells leading to hyperpolarisation and making them less excitable - Vasodilation

Target is ATP-sensitive K+ channel

24
Q

Ivabradine

A

Inhibits If channels (Pacemaker Na/K currents in the SAN)

Reduces heart rate

(Might be potassium channel activators)

25
Q

Antiplatelet Drugs

A

To prevent thromboembolism

  • -> Low dose aspirin
  • -> Clopidogrel is good but has issues over resistance
26
Q

What is the biological mechanism behind statins (simply)

A

HMG-CoA reductase inhibitors which inhibit the synthesis of cholesterol by the body

27
Q

Effect of statins on the liver

A

Statins inhibit cholesterol synthesis, so body compensates by expressing more LDL receptors, leading to an increased uptake of LDL from plasma by the liver

This is a more significant effect of statins

28
Q

Atorvastatin

A

The go-to statin

Reduces LDL synthesis and increases LDL uptake in liver

29
Q

Rhabdomyolysis

A

The muscle itself breaks down, leading to release of muscle fibre content into blood

30
Q

Side effects of statins

A

Muscle damage

  • Myopathy
  • Rhabdomyolysis

Increased diabetes risk
Monitor liver functions

31
Q

What might statins interact with

A

Macrolides
Grapefruit juice
Calcium Channel Blockers

32
Q

NICE guidance of statins

A

Primary Prevention: Treat patient with >10% risk of CV disease over next 10 years

20mg atorvastatin (low intensity)

Secondary Prevention: 80mg Atorvastatin (high intensity)

33
Q

Process of angina treatment

A
34
Q

Which calcium channel blockers can be used alongside beta blockers

A

Dihydropyridines can be used alongside beta blockers, but rate-liming Ca blockers are fatal with beta blockers

35
Q

Post-myocardial infarction prescriptions to prevent secondary MI

A

Beta-blockers
ACE inhibitor
Statins
Antiplatelet drugs

Medicine 2 Weeks 1 - 6 (54 decks)

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