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Heart Failure RCM:5 > Cardiovascular Therapeutics > Flashcards

Cardiovascular Therapeutics Flashcards

1
Q

What is ischaemic heart disease a consequence of

A

Atherosclerosis within the coronary artery

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2
Q

Which gender has a higher risk of heart disease

A

Males

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3
Q

What is stable angina

A

Chest pain on exertion which go away at rest

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4
Q

What is unstable angina

A

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

-SYmptoms are there at rest

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5
Q

What is coronary artery bypass grafting

A

Bypassing the blockage

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6
Q

What is angioplasty

A

Advance catheter into coronary circulation and then break open a ‘balloon’ to break open the blockage

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7
Q

What is the standard procedure to overcome a heart attack

A

Angioplasty and place a stent in

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8
Q

What is the pharmacological management of angina

A

Given GTN spray under tongue and acts by the release of nitrous oxide

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9
Q

How does GTN act

A

Releases nitrous oxide which causes venodilatation which leads to a decrease in preload and a reduction in cardiac work

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10
Q

If a patient is given oral nitrates, what is the problem

A

Prolonged exposure can reduce effectiveness

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11
Q

How to overcome the reduced nitrate effectiveness caused by oral nitrates

A

2 doses rather than 3 per day and then add a tablet in substitution for one of the doses

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12
Q

Best therapy for angina (FIRST CHOICE DRUGS)

A

Beta blockers (atenolol)

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13
Q

What does atenolol do

A

Blocks beta 1 adrenoceptors which reduces the force of contraction and slows the heart down

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14
Q

When does coronary flow only occur during

A

Diastole

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15
Q

What does atenolol do to coronary Flow

A

Coronary flow only occurs during diastole so by slowing the heart, the diastolic period will be increased- as will the time for coronary blood flow so coronary blood flow is increased

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16
Q

When should atenolol be stopped

A

When the patient has heart failure as the heart failure will get worse

17
Q

IF the patient develops heart failure, what should you do in regards to drugs

A

Stop the high dose atenolol and prescribe a really small dose of visoprolol

18
Q

If you can’t prescribe a beta blocker for someone with ischaemic heart disease, what would you prescribe

A

Calcium channel blocker

19
Q

What are the two classes of calcium channel blockers

A

Dihydropyridines and verapamil

20
Q

What is verapamil do

A

Acts on cardiac muscle and reduces Ca2+ entry which reduces force of contraction

-Also has anti-arrhythmic activity

21
Q

What is verapamil a type of

A

rate limiting agent

22
Q

What do dihydropyridines do

A

Don’t affect the heart- Only acts on vascular smooth muscle and cause vasodilatation

23
Q

What do rate limiting agents act on

A

Cardiac muscle

24
Q

Can you use rate limiting agent when the person has heart failure

A

No as they will worsen the heart failure

25
Q

What is Nicorandil

A

Vasodilator (potassium channel activator)

26
Q

What does Ivabradine do

A

Reduces heart rate

27
Q

What other drugs can you use with a person with ischaemic heart disease and why

A

Antiplatelet drugs as there is an increased risk of platelets sticking to a stenosis

28
Q

What anti platelet drugs are used when a person has ischaemic heart disease

A

Low dose aspirin

Clopidogrel

29
Q

What are statins

A

HMG CoA Reductase inhibitors so they inhibit cholesterol synthesis

30
Q

What shouldn’t statins be used in conjunction with

A

Macrolides (antibiotics)
Grapefruit juice
Calcium channel blockers

31
Q

First course of action if the patient has stable angina

A

GTN for relief and then assess the cardiovascular risk

32
Q

After assessing the cardiovascular risk, what is the next course of action

A
  • Aspirin or clopidogrel prescription
  • Statin
  • Controlling BP
  • Lifestyle advice ie weight loss and stopping smoking
33
Q

What to do after prescribing aspirin/clopidogrel and also giving lifestyle advice

A

Preventative measures like giving a beta-blocker and an oral nitrate (or a calcium channel blocker if a beta blocker can’t be used)

34
Q

If the beta blocker isn’t enough, then what can you prescribe

A

calcium channel blocker

35
Q

What is the MAJOR CAUTION WHEN prescribing a beta blocker and a calcium channel blocker at the same time

A

Can’t use a rate limiting calcium channel blocker as that is FATAL, so you must ONLY USE A DIHYDROPYRAMIDINE

Heart Failure RCM:5 (10 decks)

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