Cardiovascular Therapeutics Flashcards
What is ischaemic heart disease a consequence of
Atherosclerosis within the coronary artery
Which gender has a higher risk of heart disease
Males
What is stable angina
Chest pain on exertion which go away at rest
What is unstable angina
Plaque rupture and the formation of a non-occlusive thromboembolism or vasospasm
-SYmptoms are there at rest
What is coronary artery bypass grafting
Bypassing the blockage
What is angioplasty
Advance catheter into coronary circulation and then break open a ‘balloon’ to break open the blockage
What is the standard procedure to overcome a heart attack
Angioplasty and place a stent in
What is the pharmacological management of angina
Given GTN spray under tongue and acts by the release of nitrous oxide
How does GTN act
Releases nitrous oxide which causes venodilatation which leads to a decrease in preload and a reduction in cardiac work
If a patient is given oral nitrates, what is the problem
Prolonged exposure can reduce effectiveness
How to overcome the reduced nitrate effectiveness caused by oral nitrates
2 doses rather than 3 per day and then add a tablet in substitution for one of the doses
Best therapy for angina (FIRST CHOICE DRUGS)
Beta blockers (atenolol)
What does atenolol do
Blocks beta 1 adrenoceptors which reduces the force of contraction and slows the heart down
When does coronary flow only occur during
Diastole
What does atenolol do to coronary Flow
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
When should atenolol be stopped
When the patient has heart failure as the heart failure will get worse
IF the patient develops heart failure, what should you do in regards to drugs
Stop the high dose atenolol and prescribe a really small dose of visoprolol
If you can’t prescribe a beta blocker for someone with ischaemic heart disease, what would you prescribe
Calcium channel blocker
What are the two classes of calcium channel blockers
Dihydropyridines and verapamil
What is verapamil do
Acts on cardiac muscle and reduces Ca2+ entry which reduces force of contraction
-Also has anti-arrhythmic activity
What is verapamil a type of
rate limiting agent
What do dihydropyridines do
Don’t affect the heart- Only acts on vascular smooth muscle and cause vasodilatation
What do rate limiting agents act on
Cardiac muscle
Can you use rate limiting agent when the person has heart failure
No as they will worsen the heart failure
What is Nicorandil
Vasodilator (potassium channel activator)
What does Ivabradine do
Reduces heart rate
What other drugs can you use with a person with ischaemic heart disease and why
Antiplatelet drugs as there is an increased risk of platelets sticking to a stenosis
What anti platelet drugs are used when a person has ischaemic heart disease
Low dose aspirin
Clopidogrel
What are statins
HMG CoA Reductase inhibitors so they inhibit cholesterol synthesis
What shouldn’t statins be used in conjunction with
Macrolides (antibiotics)
Grapefruit juice
Calcium channel blockers
First course of action if the patient has stable angina
GTN for relief and then assess the cardiovascular risk
After assessing the cardiovascular risk, what is the next course of action
- Aspirin or clopidogrel prescription
- Statin
- Controlling BP
- Lifestyle advice ie weight loss and stopping smoking
What to do after prescribing aspirin/clopidogrel and also giving lifestyle advice
Preventative measures like giving a beta-blocker and an oral nitrate (or a calcium channel blocker if a beta blocker can’t be used)
If the beta blocker isn’t enough, then what can you prescribe
calcium channel blocker
What is the MAJOR CAUTION WHEN prescribing a beta blocker and a calcium channel blocker at the same time
Can’t use a rate limiting calcium channel blocker as that is FATAL, so you must ONLY USE A DIHYDROPYRAMIDINE
