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Heart FIlure > Cardiovascular Therapeutics > Flashcards

Cardiovascular Therapeutics Flashcards

1
Q

What is typically prescribed for chronic heart failure?

A

ACEIs, diuretics, β blockers

digoxin?

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2
Q

What is typically prescribed for hypertension?

A

ACEIs, calcium channel inhibitors

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3
Q

Give two examples of ischaemic heart disease

A

Angina

MI

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4
Q

What to prescribe for LV dysfunction when there are persistent symptoms after use of ACEI/β blockers?

A

cough - ATRA

aldosterone antagonist or hydralazine plus nitrate

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5
Q

What to prescribe for LV dysfunction when there are persistent symptoms after use of aldosterone antagonist/hydralazine plus nitrate?

A

AF - digoxin

sinus - ivabradine

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6
Q

What is IHD an important cause of?

How?

A

congestive heart failure
MI - destroyed part of the heart
or change in ischaemia decreases function of myocytes

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7
Q

What causes IHD?

A

associated with atherosclerosis within coronary artery - impaired blood flow or thromboembolic occlusion
coronary blood flow does not match demand of the muscle

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8
Q

When do symptoms begin to occur?

A

stenosis of the coronary artery due to atheroma

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9
Q

Risk factors of IHD

A 
male (female hormones protect)
family history (<55 m, <65 f)
smoking
diabetes
hypercholesterolaemia - high LDL:HDL
hypertension
sedentary lifestyle
obesity
dental hygiene
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10
Q

Major varities of angina

A

stable

unstable

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11
Q

What is stable angina?

A

atherosclerotic disease which limits heart’s ability to respond to increased demand
symptoms on exertion, relieved by rest

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12
Q

What is unstable angina?

A

plaque rupture and the formation of a non-occlusive thromboembolism OR vasospasm
symptoms at rest

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13
Q

How to diagnose stable angina?

A

History - chest pains on exertion
stable angina: pain induced by exercise and relieved by rest
GTN - nitrate spray, rapid relief
ECG - ST segment depression - below baseline
Angiography of coronary arteries - catheter, squirt radioactive dye

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14
Q

Management of stable angina

A

lifestyle - stop smoking, exercise, diet (fruit, veg, oily fish), weight
coronary artery bypass grafting
angioplasty and stenting

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15
Q

What is PTCA

A

percutaneous transluminal coronary angioplasty

treatment for IHD

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16
Q

Procedure for PTCA

A

catheter into coronary artery, while taking x-rays
inflate balloon to open vessels
stent inserted, some have drug eluting chemicals which inhibit vascular growth

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17
Q

What are ps undergoing PTCA given beforehand?

and why?

A

anti-platelets and heparin

inflation of balloon is thrombogenic - prevent further coagulation

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18
Q

Pharmalogical management of stable angina

A 
nitrates - glyceryl trinitrate (GTN) via release of NO, spray under the tongue - rapid relief
causes venodilatation (main point) and coronary vasodilatation
19
Q

What happens if angioplasty occurs without a stent?

A

restenosis - blocked again by more plaque due to damage to the blood vessel and therefore further coagulation

20
Q

What does venodilatation do?

A

decreases preload and reduces cardiac work

21
Q

Action of GTN

A

glyceryl trinitrate donates NO into circulation

activates guanylyl cyclase and leads to release of cGMP, causes venodilatation

22
Q

What type of nitrates can cause problematic nitrate tolerance?

A

oral nitrates

23
Q

How to prevent nitrate tolerance?

A

aim for nitrate free period

2 doses, rather than 3 per day eg. at night

24
Q

What is the first choice drug for prevention against IHD?

A

β-blocker - atenolol

25
Q

How is atenolol anti-anginal? Why does this work?

A

negative inotropic and chronotropic effects
coronary flow is only during diastole, so slowing the heart will increase diastolic period, including the time for coronary blood flow
therefore it reduces cardiac work and prevents symptoms

26
Q

How does atenolol reduce the risk of MI?

A

anti-arrhythmic effects reduce risk of MI

27
Q

What dose of atenolol is used for angina?

A

high dose atenolol

28
Q

Problems of atenolol

A

p with angina can develop chronic heart failure which is worsened by high dose atenolol - reduces contractility (-ve inotrope)
therefore use bisoprolol

29
Q

Alternative to beta blockers

A

calcium channel blockers

eg. amlodipine

30
Q

Types of calcium channel blockers

A

rate limiting agents (diltiazem and verapamil)

dihydropyridines (amlodipine)

31
Q

Rate limiting agents specific action

A 
block calcium channels on heart and smooth muscle - myocardial depressant and bradycardic actions, reduce cardiac work
verapamil - also exerts class IV anti-arrhythmic activity
32
Q

Dihydropyridines specific action

A

act just on smooth muscle

33
Q

Effect of calcium channel blockers

A

vasodilatation, improve coronary blood flow

prevents symptoms

34
Q

What are calcium channel blockers used for?

A

IHD

AF

35
Q

Advantages and disadvantages of rate limiting agents

A

does not cause reflex tachycardia

but worsens heart failure

36
Q

What else may ps with IHD be prescribed?

A

ACEIs
potassium channel activators - nicorandil
Ivabradine
antiplatelet drugs - low dose aspirin and clopidogrel
statins

37
Q

How does nicorandil work?

A

combined NO donor and activator of ATP-sensitive K channels

causes hyperpolarisation and vasodilatation

38
Q

How does ivabradine work?

A

inhibits funny current channels (pacemaker current in SAN)

reduces heart rate

39
Q

How do statins work?

A

prevents synthesis of cholesterol
HMG-CoA reductase inhibitors (first step of synthesis)
therefore causes secondary response: up-regulation of hepatic LDL receptors - promotes LDL uptake

40
Q

Example of statin

A

atorvastatin

41
Q

Problems of statins

A

rarely causes muscle damage
interactions with macrolides (blocks metabolism of simvastatin), grapefruit juice and some calcium channel blockers - interact, use lower dose statin

42
Q

When are statins used?

A

primary prevention - risk

secondary prevention - already exhibited problem

43
Q

Steps of managing stable angina

A

GTN
assess CV risk - aspirin/clopidogrel, statin, lifestyle, BP, ACEI
prevention - beta/calcium channel blocker +/- oral nitrate
refractory - dihydropyrimidine, (nicorandil, ivabradine)

44
Q

What combination is fatal?

A 
rate-limiting CCB and beta-blocker
causes asystole (death)

Heart FIlure (9 decks)

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