Clinical Pharmacology of Stable Coronary Artery Disease Flashcards
What is atypical angina?
Defined as stable angina but with symptoms not clearly identifiable as ischaemic chest pain:
-Breathlessness
-Burning/reflux/burping
What are some of the modifiable risk factors regarding stable CAD?
Hypertension
Smoking
Diabetes
Hyperlipidaemia
What are some of the non-modifiable risk factors regarding stable CAD?
Family history
Male
Post menopausal females
Other arterial disease
Why will any type of angina occur?
There is a myocardial oxygen supply/demand mismatch.
What increases myocardial demand?
Heart rate
Preload
Afterload
Myocardial contractility – systolic function
Myocardial relaxation – diastolic function
Myocardial wall stress
What are the steps when trying to treat stable CAD?
Relieve symptoms
Slow/halt the disease process
Prevent myocardial infarction
Prevent premature death
How do we improve the symptoms of those with stable CAD?
Reduce workload
Improve coronary blood flow
What are some types of treatments which are rate limiting?
Beta-adrenoreceptor antagonist
Calcium channel blocker (L-type)
Ivabradine (f-channel)
What are some types of treatments which are vasodilators?
Nitrates – nitric oxide
Calcium channel blocker
Potassium channel activator
Give an example of a drug which is a sodium channel activator.
Ranolazine
Name some antiplatelet drugs
Aspirin
Clopidogrel
Ticagrelor
Prasugrel
Name some cholesterol lowering drugs.
HMG-CoA reductase inhibitors
Fibrates
PCSK-9 inhibitors
What is the mechanism of action for beta blockers?
Reversible inhibitor of the beta1 and beta2 receptors
Block the sympathetic system
Name some cardio selective beta blockers.
Bisoprolol
Metoprolol – shorter acting
Atenolol
Name some non-selective beta blockers.
Carvedilol
Propranolol
What is primarily treated in terms of angina?
HR
Afterload
What are some of the side effects of beta blockers?
Asthma
Peripheral vascular disease
Raynaud’s syndrome
Acute heart failure
Bradycardia or heart block
Fatigue
Impotence
Which group of people do you need to be careful with giving beta blockers to?
Those who are highly asthmatic.
Which group of people do you need to be careful with giving beta blockers to?
Those who are highly asthmatic.
Which group of people do you need to be careful with giving beta blockers to?
Those who are highly asthmatic.
->Can give highly selective beta blockers as long as they haven’t recently been in hospital related to asthma
What are the benefits of beta blockers?
Heart rate – reduce myocardial workload
Contractility
Systolic wall tension – improve relaxation
Increases diastolic perfusion time
Reduces rate of ischaemic events and mortality
What are the subtopics of calcium channel blockers and what does this mean?
Dihydropyridine- causes vasodilation
Non-dihydropyridine CCB- affects HR
What are the mechanisms of action for calcium channel blockers?
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
Give some examples of dihydropyridine drugs.
Amlodipine
Felodipine
Nifedipine
Give some examples of non-dihydropyridine drugs (NDHP).
Verapamil
Diltiazem
-pls write the drug names out Lucy
What are the benefits of calcium channel blockers?
Heart rate - Exclusively NDHP like Verapamil/Diltiazem
Reduce contractility (NDHP)
Reduce afterload (DHP)
Increases diastolic perfusion time (NDHP)
What are some of the side effects/cautions to be aware of when using calcium channel blockers?
Peripheral oedema (DHP)
Bradycardia/heart block (NDHP)
Hypotension (Both)
Reduced LV function
Headache
Flushing
Which groups of calcium channel blockers should you only use on people with a normal LV function?
Dihydropyridine drugs
How do the vasodilator of nitrates work?
Nitrates release Nitric Oxide which potentiates smooth muscle relaxation
What is the mechanism of action for nitrates?
Nitric Oxide mediated smooth muscle relaxation
Long-acting preparations most effective
Non-selective
What are the side effects/ cautions of nitrates?
Severe aortic stenosis
Hypotension
Headache- common as vasodilate everything
What are the benefits of nitrates?
- Reduce preload and afterload (therefore myocardial workload)
- Improve coronary flow via vasodilation (Epicardial arteries and improve blood supply)
- Doesn’t reduce mortality
What is Nicorandil?
Vasodilator- potassium channel activator
Used as a second hand treatment
What is the mechanism of action for potassium channel activators, like nicorandil?
Activates ATP sensitive potassium channels causing potassium influx
What are some of the side effects of potassium channel activators, like nicorandil?
Hypotension
GI ulceration
What is important to note about individuals with previous GI ulcers?
Cannot give them nicorandil
What is a type of second line treatment for rate limitation?
Ivabradine- funny channel inhibitor
Where are the funny channels affected by ivabradine?
In the SA node
When does ivabradine (funny channel inhibitors) work?
Only works when patient is in sinus rhythm.
What is the mechanism of action for funny channel inhibitors?
Funnily enough, they inhibit funny channels in the SA node
What are the benefits of funny channel inhibitors?
Heart rate – when in sinus rhythm
Reduces rates of infarction
Who cannot get given funny channel inhibitors?
Anyone with SA node dysfunction.
What does lipid lowering therapy do?
Lowers cholesterol production
Name some HMG-CoA Reductase inhibitors
Atorvastatin
Simvastatin
Rosuvastatin
Name two types of antiplatelet treatment.
Thromboxane A2 inhibitor
P2Y12 inhibitors
Give some examples of a P2Y12 inhibitor and how it works.
Clopidogrel
Ticagrelor
Prasugrel
Inhibits platelet activation via ADP mediated pathway
Give an example of thromboxane A2 inhibitors and how it works.
Aspirin
Inhibits platelet activation via TXA2 pathway
