Coronary Heart Disease Drugs

Question 1

Cardiovascular disease (CVD

Answer 1

Cardiovascular disease (CVD): disease of the heart & blood vessels.
- most common manifestation of CVD: coronary heart disease (CHD)
CHD is caused by the narrowing of the arteries that supply the heart and is due to a gradual build-up of fatty material called atheroma.
- also known as coronary artery disease and ischaemic heart disease.

Question 2

Angina pectoris

Answer 2

Crushing pain in chest that may radiate to arm, neck or jaw
- Most commonly on exertion
The pain results from cardiac ischaemia

Question 3

Nitrates (nitrovasodilators)

Answer 3

Commonest: Glyceryl Trinitrate (GTN)
Used for > 100 yrs for angina pain
Fast-acting
Sublingual tablet, nasal spray, transdermal patch
Unwanted effects common
Tolerance develops
Preparations differ in “shelf-life” (tablets go off quickest)
Short- and longer-acting nitrates used
Rapidly metabolized by liver (esp. GTN)

Question 4

How nitrovasodilators work?

Answer 4

Nitrovasodilators produce:
NO (Nitric oxide)
↑ cGMP (in muscle cells)
Muscle relaxes (vessel dilates)

Question 5

Nitrovasodilators and systemic arteries

Answer 5

Systemic arteries–> Less resistance (reduced BP)–> Less work for heart (LV) – less O2 demand

Question 6

Nitrovasodilators and large veins

Answer 6

Large veins (biggest effect) –>More blood in venous system – less back to heart / unit time –> Heart fills less – less work – less O2 demand

Question 7

Nitrovasodilators and Cerebral arteries

Answer 7

Cerebral arteries –> Cerebral blood flow increased –> “Throbbing” / “pounding” headache

Question 8

Side effect of Nitrates

Answer 8

Throbbing headache - cerebral vasodilatation

Dizziness (esp. on getting up) – lowered blood pressure

Question 9

STATINS

Answer 9

HMG CoA reductase inhibitors
lower eleveated LDL cholesterol levels, resulting in substantial reduction in coronary events and death from CHD.
they are antihyperlipidemic agents and inhibit the first committed enzymatic step of cholesterol synthesis.

Question 10

Benefits of Statins

Answer 10

plaque stabilization
improvement of coronary endothelial function
inhibition of platelet thrombus formation
anti-inflammatory activity

Question 11

side effects of statins

Answer 11

few actual reported cases
Liver - biochemical abnormalities in liver function
Muscle - Myopathy and rhabdomyolysis (disintegration of muscle)

Question 12

drug interations of statins

Answer 12

the HMG CoA reductase inhibitor increase warfarin levels. therefore it is important to evaluate pro-thrombin levels frequently.

Question 13

What is the most common side effect of antihyperlipidemic drug therapy?

Answer 13

Gastrointestinal disturbances

Question 14

A 56 year-old patient complains of chest pain following any sustained exercise. He is diagnosed with atherosclerotic angina. He is prescribed sublingual nitroglycerin for treatment of acute chest pain. what is the most likely adverse effect?

Answer 14

Throbbing headache