Coronary ischemic heart disease

Question 1

List the 4 classes of drug used in the treatment of acute coronary syndrome

Answer 1

1. Beta blockers
2. Calcium channel blockers (DHP & non-DHP)
3. Ivabradine
4. Nitrates

Question 2

Name the 2 nitrates used in ACS

Answer 2

1. Nitroglycerin (also known as glyceryl TRInitrate)
2. Isosorbide DInitrate

Question 3

What is the MOA of nitrates?

Answer 3

Vasodilators
- Reduce peripheral vascular resistance
- Decrease preload (due to venous dilation and more peripheral pooling of blood)
- Decreases afterload

All in all, this reduces cardiac oxygen consumption and hence relieves the angina.

Question 4

What is the specific clinical use for isosorbide dinitrate?

Answer 4

PROPHYLAXIS of angina pectoris

Question 5

List 2 adverse effects of nitrates

Answer 5

Baroreflex: reflex tachycardia

Vasodilation: Hypotension

Meningeal artery vasodilation: headaches

Question 6

Name 2 DHP calcium channel blockers

Answer 6

Nifedipine, amlodipine

Question 7

Name 2 non-DHP calcium channel blockers

Answer 7

Verapamil, diltiazem

Question 8

What are the 3 conditions that CCB are used in treatment for?

Answer 8

1. Anti-arrhythmic
2. Anti-angina
3. Anti-hypertensive

Question 9

What is the MOA of CCB in treatment of angina pectoris?

Answer 9

Reduce intracellular concentration of calcium

Reduce myocardial contractility

Reduce cardiac o/p and oxygen requirement of cardiac muscles

Question 10

Compare verapamil, diltiazem and nifedipine in terms of their effectiveness in lowering BP, vasodilation and cardiac depressant

Answer 10

Lowering BP: all same

Vasodilator: N>D>V

Cardiac depressant:
V>D>N

Question 11

Name 2 adverse effects of CCB

Answer 11

Cardiac depression: bradycardia, AV blocker, heart failure