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Cardiovascular system > clinical pharmacology of stable coronary artery disease > Flashcards

clinical pharmacology of stable coronary artery disease Flashcards

1
Q

what are the acute coronary syndromes?

A

MI- STEMi and NSTEMI

unstable angina pectoris

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2
Q

what are the two stable coronary artery diseases?

A

angina pectoris

silent ischaemia

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3
Q

what are the risk factors for coronary artery disease?

A 
hypertension
smoking
hyperlipidaemia
hyperglycaemia
male
post-menopausal females
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4
Q

in what general situation would stable coronary artery disease cause angina?

A

anything which increases HR, stroke volume or blood pressure

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5
Q

what is silent ischaemia?

A

non-typical form of angina where there is no chest pain, just symptoms such as SOB or fatigue

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6
Q

what are determinants of demand which if increased will cause demand ischaemia?

A
  • HR
  • systolic BP
  • myocardial wall stress
  • myocardial contractility
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7
Q

what arevthe determinants of supply which if altered cause supply ischaemia?

A
  • coronary artery diameter and tone
  • collateral blood flow
  • perfusion pressure
  • heart rate (duration of diastole)
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8
Q

which arteries does atherosclerosis normally affect?

A

muscular arteries such as coronary and cerebral vessels

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9
Q

what are the general wyays that drugs can treat myocardial ischaemia?

A
  • decreasing myocardial oxygen demand by reducing cardiac workload
  • increasing the supply of oxygen to ischaemic myocardium
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10
Q

what are the 3 ways that drugs decrease the myocardial oxygen demand?

A

decreasing myocardial workload:

  • reduce heart rate
  • reduce myocardial contractility
  • reduce afterload
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11
Q

what are the general aims of treatments of stable coronary artery disease?

A
  • relieve symptoms
  • halt the disease process
  • regression of the disease process
  • prevent myocardial infarction
  • prevent death
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12
Q

what are the rate-limiting drug therapies for stable coronary artery disease?

A

Beta-blockers
ivabradine
calcium channel blockers

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13
Q

what are the vasodilating drugs used to treat stable coronary artery disease?

A

Calcium channel blockers

Nitrates (oral and sublingual)

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14
Q

what are the 2 beta blockers used to treat stable angina?

A

Bisoprolol

atenolol

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15
Q

what are the actions of Beta Blockers?

A
  • decrease heart rate
  • decrease the force of myocardial contraction
  • decrease cardiac output
  • decrease velocity of contraction
  • decrease blood pressure
  • protect cardiomyocytes from oxygen free radicals during ischaemic episodes
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16
Q

what is the “rebound phenomenon” associated with beta Blocker cessation?

A

sudden cessation of Beta Blockers may precipitate MI.

Best to slowly wean off the treatment.

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17
Q

what are the contraindications of Beta blockers?

A 
asthma
peripheral vascular disease
raynauds syndrome
heart failure
bradycardia
heart block
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18
Q

what are the adverse drug reactions associated with Beta blockers?

A 
tiredness
lethargy
impotence
bradycardia
bronchospasm
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19
Q

what are the drugs that Beta blockers can interact with and what is the negative effect causes?

A
  • hypotensive agents: hypotension
  • other rate imiting drugs ;like verapamil and diltiazem: bradycardia
  • negative inotropic agents such as veramipril, di;tiazem or disopyramide: cardiac failure
  • antagonism of anti hypertensive actions of Beta blockers by NSAIDs
  • exaggerates hypoglycaemic actions of insulin and hypoglycaemics but also masks them
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20
Q

what are the calcium channel blockers used in the treatment if stable coronary disease?

A 
rare limiting:
diltiazem
verapamil
vasodilating:
amlodipine
nifedipine
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21
Q

what are 2 rate limitng CCBs?

A

diltiazem

verapamil

22
Q

what are 2 vasodilating CCBs?

A

nifadipine

amlodipine

23
Q

what do vasodilating CCBs do?

A

reduce vascular tree tone and produce vasodilatation and reduce afterload

24
Q

what do rate limiting CCBs do?

A

reduce heart rate and and the force or myocardial contractility

25
Q

which form of nifedipine is never used for stable coronary artery disease?why?

A

immediate release, evidence suggests it may precipitate acute MI or stroke

26
Q

why is immediate release nifedipine never used in post MI and unstable angina patients?

A

increases morbidity and mortality in post MI patients and increases the risk of infarction and death in unstable angina patients

27
Q

what are the adverse drug reactions of calcium channel blockers?

A

ankle oedema (doesnt respond to diuretucs)
headache
flushing
palpitations

28
Q

what are the three nitrovasodilators?

A

glyceryl trinitrate (GTN)
isosorbide mononitrate
isosorbide dinatrate

29
Q

what forms does GTN come in?

A

sublingual, buccal, transdermal

30
Q

what is the route of administration of isosorbide dinitrate and isosorbide mononitrate?

A

sustained release formulation tablets

31
Q

which form of nifedipine is used for the treatment of acute coronary syndrome?

A

slow release

32
Q

what do nitrates do to blood vessels to treat stable coronary disease?

A
  • increases arteriolar dilatation, reducing cardiac afterload
  • increased venodilatation so reducing venous return, reducing preload
  • relieves coronary spasm
  • redistributes myocardial blood flow to ischaemic areas of myoiocardium
33
Q

in what situation is GTN used?

A

rapid treatment of angina pain

34
Q

in what situations are oral nitrates used?

A

-once a day sustained release so used in prophylaxis to prevent treatments

35
Q

in what situations are IV nitrates used?

A

main stay in the treatment of unstable angina where they are used in combination with heparin

36
Q

what is nitrate tolerance? and how is it avoided?

A

tolerance to the effects of nitrate therapy. Can occur rapidly. overcome y giving asymmetric doses of nitrate at 8 am and 2 pm

37
Q

what are the adverse drug reactions of nitrate?

A

headache

hypotension (GTN syncope)

38
Q

what us the action of the stable coronary artery drug, Nicorandil?

A
  • ischaemic precondition of myocardium
  • dilation of coronary resistance arterioles
  • vasodilation of coronary epicardial arteries
39
Q

what is the action of ivabridine?

A

selective sinus node If channel inhibitor, so slows heart rate and myocardial oxygen demand

40
Q

what side effects does nicorandil have?

A

produces Crohn’s like symptoms

41
Q

what is the action of ranolizine?

A

reduces tension in heart wall leading to decreased oxygen requirements for the muscle

42
Q

what are the indications of aspirin treatment in stable coronary syndrome?

A
  • adults unable to tolerate or with a contraindication to the use of Beta blockers
  • or in combination with Beta blockers when Beta blockers on their own are inadequate
43
Q

what can aspirin do to prognosis in acute MI?

A

reduce mortality

and in combination with streptokinase can reduce mortality and reinfarction

44
Q

what can aspirin do to prognosis in unstable angina?

A

reduce MI and death risk

45
Q

why is aspirin used in secondary prevention?

A

reduce reinfarction and combined vascular event risk

46
Q

what is the most common cause of admission to hospital with GI bleed?

A

low dose aspirin

47
Q

which antiplatelets are used in stable coronary artery disease?

A

aspirin
clopidogrel
ticagrelor

48
Q

what is the advantage of clopidogrel over aspirin?

A

same bleeding but less GI bleeding

49
Q

what are the 3 cholesterol lowering drugs commonly used in treatment of stable coronary artery disease?

A

simvastatin
pravastatin
atorvastatin

50
Q

describe a common treatment regimen?

A
  1. Beta blocker
  2. rate limiting CCB (if Beta blocker contraindicated or not adequate)
  3. dihydropiridine (vasodilating) CCB
  4. Ivabradine/ ranolazine
  5. aspirin
  6. statin
  7. long acting nitrate
  8. nicorandil
  9. PCI
51
Q

what is a normal treatment regime for the relief of angina symptoms?

A
  1. short acting GTN plus Beta blocker and/or CCB
  2. Ivabradine, long-acting nitrates, nicorandil, ranolazine, trimetazidine
  3. consider PCI or CABG
52
Q

what is a normal treatment regime for the prevention of cardiovascular events from stable coronary artery disease?

A
  1. lifestyle management, control of risk factors

2. aspirin (clopidogrel if aspiin intolerence), statins, consider ACEI or ARBs (angiotensin receptor blockers.

Cardiovascular system (40 decks)

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