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Systems: Cardiovascular > Clinical Pharmacology of Stable Coronary Heart Disease and Angina > Flashcards

Clinical Pharmacology of Stable Coronary Heart Disease and Angina Flashcards

1
Q

What is silent ischaemia?

A

No pain

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2
Q

Who is often effected by this?

A

Diabetics

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3
Q

What are the risk factors of stable angina?

A
  • Hypertensive
  • Male
  • Hyperlipidaemia
  • Hyperglycaemia
  • Male
  • Post-menopausal female
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4
Q

What is hyperlipidaemia a disease of?

A

Muscular arteries —coronary

cerbral

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5
Q

What is a fatty streaks?

A

Subendothelial accumulation of large foam cells (derived from macrophages plus SM cells) Filled with lipid

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6
Q

What a fibrous plaque?

A
  • More advanced and the cause of disease
  • Develop from fatty streaks
  • Projects into arterial lumen
  • Reduced blood flow
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7
Q

Where are the changes taking place when an artery becomes atherscerlosed?

A

intimal layer

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8
Q

What accumulates in an atheroma?

A

Monocytes, lymphocytes, foam cells and connective tissue

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9
Q

What is the origin of of the foam cells?

A

Mostly muscle origin

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10
Q

What is SCAD?

A

Stable coronary artery disease

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11
Q

Why does SCAD arise?

A

mismatch between myocardial blood/oxygen supply and demand

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12
Q

What is demand ischaemia?

A

Ischaemia during stress

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13
Q

What determines demand?

A
  • Heart rate
  • Systolic blood pressure
  • Myocardial wall stress
  • Myocardial contractility
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14
Q

What is supply ischaemia?

A

Ischaemia at rest

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15
Q

Determinants of supply?

A
  • Coronary artery diameter and tone
  • Collateral blood flow
  • Perfusion
  • Heart rate
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16
Q

How do drugs decrease myocardial oxygen demand?

A

Reducing cardiac workload

  • Reduce heart rate
  • Reduce myocardial contractility
  • Reduce afterload
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17
Q

Name the rate limiting drugs for SCAD?

A
  • Beta-adrenoceptor antagonists
  • Ivabradine
  • Calcium channel blockers
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18
Q

Name the vasodilations used to teat SCAD

A

Calciumchannel blockers

Nirates

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19
Q

What do beta blockers act on?

A
  • Heart rate
  • Contractility
  • Systolic
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20
Q

What do beta blockers do to subendocardium?

A

Allows improved perfusion by increasing diastolic perfusion time

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21
Q

name 2 beta blockers?

A
  • Bisoprolol

- atenolol

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22
Q

What are beta blockers?

A

They are reversible anatgonists of the B1 and B2 receptors

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23
Q

What do beta blockers do?

A
  • decrease the heart rate
  • Decrease contracility
  • Decrease CO
  • Decrease BP
  • Protect cardiomyocytes from oxygen free radicals formed during ischaemic episodes
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24
Q

What is rebound phenomena?

A

-Sudden cessation of beta blocker therapy may precipitate myocardial infarction

25
Q

What are the contradictory conditions to prescribing beta blockers?

A
  • Asthma
  • peripheral vascular disease
  • Raynauds syndrome
  • Heart failure (on sympathetic drive)
  • Bradycardia/Heart block-over do
26
Q

What is raynauds syndrome?

A

smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas (vasospasm).

27
Q

What are the adverse drug reactions of beta blockers?

A
  • Tiredness/fatigue
  • Lethargy
  • Impotence
  • Bradycardia
  • Bronchospasm
28
Q

What can happen when beta blockers are given with other rate limiting drugs ]?

A

Bradycardia

29
Q

Name two rate limiting drugs?

A
  • verapamil

- diltiazem

30
Q

When can beta blockers cause cardiac faiure?

A

When used with negatively ionotropic agents

31
Q

What can beta blockers mask?

A

hypoglycaemic actions of insulin or oral hypoglycaemics

32
Q

Name 3 calcium channel blockers?

A

Diltiazem
Verapamil
Amlopidpine

33
Q

how do CCB`s work?

A

Prevent clacium influx into myocytes and smooth muscle lining arteries and arterioles by blocking the L-type calcium channel

34
Q

What are the two types of calcium blockers?

A
  • Rate limiting (dilitazem verapamil)

- Vasodilating (nifedipine or amlodipine)

35
Q

What can cause MI strokes if given rapidly?

A

Nifedipine immediate release

36
Q

What are some adverse drug reactions to CCB`s?

A
  • Ankle oedema
  • headache
  • Flushing
  • Palpitaion
37
Q

Name 3 nitrovasodilators?

A
  • Glyceryl trinitrate
  • Isosrbide mononitrate
  • Isosorbide dinitrate
38
Q

How can you administer GTN?

A
  • Sublingual
  • Buccal
  • Transdermal
39
Q

How can you administer isosorbide mono/dinitrate?

A

-Sustained release formulation,tablets

40
Q

What can GTN cause?

A

Syncope

41
Q

How do nitrovasodilators relax muscle?

A

by releasing NO which then stimulates the release of cGMP which produces smooth muscle relaxation

42
Q

How do nitrovasodilators reduce myocardial oxygen consumption?

A

Reduce preload and after load

43
Q

How do nitrates relieve angina?

A
  • Arteriolar dilation
  • Venodilation (less preload less work)
  • Revlieving coronary vasospasm
  • Redistributing myocardial blood flow to ischaemic areas of the myocardium
44
Q

Do nitrates reduce morbidity?

A

NO evidence of this

45
Q

What adverse drug reactions to nitrates?

A
  • Headache

- Hypotension

46
Q

Name one potassium channel opener?

A

Nicorandil

47
Q

How do potassium channel openers work?

A
  • Activate “silent” potassium channels

- Then entry of potassium into cardiac myocytes inhibits the calcium influx and so has a negative inotropic action

48
Q

What level of treatment is potassium channel openers and why?

A
  • Third line

- Bowel ulceration

49
Q

What does Ivabradine do?

A

Is a selctive sinus node If channel inhibitor

  • Slows the diastolic depolarisation slope of the SA-node
  • Reduces heart rate and therefore O2 demand
50
Q

Name an antiplatelet agent

A

-Low does aspirin

51
Q

How does aspirin work?

A

inhibits platelet thromboxane production

52
Q

What does thromboxane do?

A

Stimulate platelet aggregation and vasoconstriction

53
Q

What is the most common cause of admission with a GI bleed

A

Low dose aspirin

54
Q

When should aspirin be given?

A

When HR is greater then 70 bpm

55
Q

How does clopidogrel work?

A

Inhibits ADP receptor activated platelet aggreagtion

56
Q

Name 3 cholesterol lowering agents?

A

Simvastatin
Pravastatin
Atorvastatin

57
Q

What do cholesterol lowering drug inhibit?

A

HMG coA reductase

58
Q

What is the regime in order for treating SCAD?

A

-Beta blockers
-rate limiting CCB
-Dihydropiridine CCB
-Ivabradine
-Aspirin
-Statin
-Nitrate
Refer refer refer

Systems: Cardiovascular (31 decks)

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