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Year 1-Cardiovascular System > Clinical Pharmacology of Stable Coronary Artery Disease > Flashcards

Clinical Pharmacology of Stable Coronary Artery Disease Flashcards

1
Q

What is atypical angina?

A

Defined as stable angina but with symptoms not clearly identifiable as ischaemic chest pain:

-Breathlessness
-Burning/reflux/burping

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2
Q

What are some of the modifiable risk factors regarding stable CAD?

A

Hypertension
Smoking
Diabetes
Hyperlipidaemia

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3
Q

What are some of the non-modifiable risk factors regarding stable CAD?

A

Family history
Male
Post menopausal females
Other arterial disease

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4
Q

Why will any type of angina occur?

A

There is a myocardial oxygen supply/demand mismatch.

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5
Q

What increases myocardial demand?

A

Heart rate
Preload
Afterload
Myocardial contractility – systolic function
Myocardial relaxation – diastolic function
Myocardial wall stress

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6
Q

What are the steps when trying to treat stable CAD?

A

Relieve symptoms

Slow/halt the disease process

Prevent myocardial infarction

Prevent premature death

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7
Q

How do we improve the symptoms of those with stable CAD?

A

Reduce workload
Improve coronary blood flow

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8
Q

What are some types of treatments which are rate limiting?

A

Beta-adrenoreceptor antagonist
Calcium channel blocker (L-type)
Ivabradine (f-channel)

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9
Q

What are some types of treatments which are vasodilators?

A

Nitrates – nitric oxide
Calcium channel blocker
Potassium channel activator

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10
Q

Give an example of a drug which is a sodium channel activator.

A

Ranolazine

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11
Q

Name some antiplatelet drugs

A

Aspirin
Clopidogrel
Ticagrelor
Prasugrel

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12
Q

Name some cholesterol lowering drugs.

A

HMG-CoA reductase inhibitors
Fibrates
PCSK-9 inhibitors

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13
Q

What is the mechanism of action for beta blockers?

A

Reversible inhibitor of the beta1 and beta2 receptors
Block the sympathetic system

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14
Q

Name some cardio selective beta blockers.

A

Bisoprolol
Metoprolol – shorter acting
Atenolol

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15
Q

Name some non-selective beta blockers.

A

Carvedilol
Propranolol

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16
Q

What is primarily treated in terms of angina?

A

HR
Afterload

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17
Q

What are some of the side effects of beta blockers?

A

Asthma
Peripheral vascular disease
Raynaud’s syndrome
Acute heart failure
Bradycardia or heart block
Fatigue
Impotence

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18
Q

Which group of people do you need to be careful with giving beta blockers to?

A

Those who are highly asthmatic.

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19
Q

Which group of people do you need to be careful with giving beta blockers to?

A

Those who are highly asthmatic.

19
Q

Which group of people do you need to be careful with giving beta blockers to?

A

Those who are highly asthmatic.

->Can give highly selective beta blockers as long as they haven’t recently been in hospital related to asthma

20
Q

What are the benefits of beta blockers?

A

Heart rate – reduce myocardial workload
Contractility
Systolic wall tension – improve relaxation
Increases diastolic perfusion time
Reduces rate of ischaemic events and mortality

21
Q

What are the subtopics of calcium channel blockers and what does this mean?

A

Dihydropyridine- causes vasodilation
Non-dihydropyridine CCB- affects HR

22
Q

What are the mechanisms of action for calcium channel blockers?

A

Prevent calcium influx into myocytes and smooth muscle arteries/arterioles by blocking L-type Ca channel

Dihydropyridine mostly relax smooth muscle
Non-dihydropyridines mostly reduce heart rate

23
Q

Give some examples of dihydropyridine drugs.

A

Amlodipine
Felodipine
Nifedipine

24
Q

Give some examples of non-dihydropyridine drugs (NDHP).

A

Verapamil
Diltiazem

-pls write the drug names out Lucy

25
Q

What are the benefits of calcium channel blockers?

A

Heart rate - Exclusively NDHP like Verapamil/Diltiazem
Reduce contractility (NDHP)
Reduce afterload (DHP)
Increases diastolic perfusion time (NDHP)

26
Q

What are some of the side effects/cautions to be aware of when using calcium channel blockers?

A

Peripheral oedema (DHP)
Bradycardia/heart block (NDHP)
Hypotension (Both)
Reduced LV function
Headache
Flushing

27
Q

Which groups of calcium channel blockers should you only use on people with a normal LV function?

A

Dihydropyridine drugs

28
Q

How do the vasodilator of nitrates work?

A

Nitrates release Nitric Oxide which potentiates smooth muscle relaxation

29
Q

What is the mechanism of action for nitrates?

A

Nitric Oxide mediated smooth muscle relaxation
Long-acting preparations most effective
Non-selective

30
Q

What are the side effects/ cautions of nitrates?

A

Severe aortic stenosis
Hypotension
Headache- common as vasodilate everything

31
Q

What are the benefits of nitrates?

A
  1. Reduce preload and afterload (therefore myocardial workload)
  2. Improve coronary flow via vasodilation (Epicardial arteries and improve blood supply)
  3. Doesn’t reduce mortality
32
Q

What is Nicorandil?

A

Vasodilator- potassium channel activator
Used as a second hand treatment

33
Q

What is the mechanism of action for potassium channel activators, like nicorandil?

A

Activates ATP sensitive potassium channels causing potassium influx

34
Q

What are some of the side effects of potassium channel activators, like nicorandil?

A

Hypotension
GI ulceration

35
Q

What is important to note about individuals with previous GI ulcers?

A

Cannot give them nicorandil

36
Q

What is a type of second line treatment for rate limitation?

A

Ivabradine- funny channel inhibitor

37
Q

Where are the funny channels affected by ivabradine?

A

In the SA node

38
Q

When does ivabradine (funny channel inhibitors) work?

A

Only works when patient is in sinus rhythm.

39
Q

What is the mechanism of action for funny channel inhibitors?

A

Funnily enough, they inhibit funny channels in the SA node

40
Q

What are the benefits of funny channel inhibitors?

A

Heart rate – when in sinus rhythm
Reduces rates of infarction

41
Q

Who cannot get given funny channel inhibitors?

A

Anyone with SA node dysfunction.

42
Q

What does lipid lowering therapy do?

A

Lowers cholesterol production

43
Q

Name some HMG-CoA Reductase inhibitors

A

Atorvastatin
Simvastatin
Rosuvastatin

44
Q

Name two types of antiplatelet treatment.

A

Thromboxane A2 inhibitor
P2Y12 inhibitors

45
Q

Give some examples of a P2Y12 inhibitor and how it works.

A

Clopidogrel
Ticagrelor
Prasugrel
Inhibits platelet activation via ADP mediated pathway

46
Q

Give an example of thromboxane A2 inhibitors and how it works.

A

Aspirin
Inhibits platelet activation via TXA2 pathway

Year 1-Cardiovascular System (41 decks)

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