Clinical Pharmacology of Stable Coronary Artery Disease

Question 1

What is Stable Angina

Answer 1

A clinical syndrome of predictable chest pain precipitated by exercise or emotional stress, which increase myocardial oxygen demand.

Question 2

What is Atypical Angina

Answer 2

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

• Breathlessness
• Burning/reflux/burping

Question 3

Name 3 RATE LIMITING pharmacotherapy

Answer 3

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

Question 4

Name 3 VASODILATOR pharmacotherapy

Answer 4

• Nitrates – nitric oxide
• Calcium channel blocker
• Potassium channel activator

Question 5

Name a SODIUM CHANNEL ACTIVATOR pharmacotherapy

Answer 5

Ranolazine

Question 6

Name 4 types of ANTIPLATELET pharmacotherapy

Answer 6

• Aspirin
• Clopidogrel
• Ticagrelor
• Prasugrel

Question 7

Name 3 CHOLESTEROL LOWERING pharmacotherapy

Answer 7

• HMG-CoA reductase inhibitors
• Fibrates
• PCSK-9 inhibitors

Question 8

Benefits of beta blockers

Answer 8

Decrease major determinants of myocardial oxygen demand

1. Heart rate – reduce myocardial workload
2. Contractility
3. Systolic wall tension – improve relaxation
4. Increases diastolic perfusion time
5. Reduces rate of ischaemic events and mortality

Question 9

Benefits of calcium channel blockers

Answer 9

1. Heart rate - Exclusively NDHP like Verapamil/Diltiazem
2. Reduce contractility (NDHP)
3. Reduce afterload (DHP)
4. Increases diastolic perfusion time (NDHP)

Question 10

Benefits of vasodilators (nitrates)

Answer 10

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

Question 11

Benefits of ivabradine

Answer 11

1. Heart rate – when in sinus rhythm
2. Reduces rates of infarction

Question 12

Benefits of sodium channel activators

Answer 12

1. Reduced O2 demand due to reduced wall stress (easier to perfuse microcirculation)
2. Beneficial antiarrhythmic effects via Na+/K+ channels (uncertain utility).

Question 13

Weaknesses of beta blockers

Answer 13

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

Question 14

Weaknesses of calcium channel blockers

Answer 14

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