CVS - Ischemic Heart Disease Flashcards
Ischemic Heart disease can be classified into
Angina
MI
Angina can be classified into
Classical Angina
Variant angina or Prinzmetal Angina or Vasospastic angina
Classical Angina
Atherosclerosis in small coronary arteries
Chest pain only during exertion
Aim of treatment in Classical Angina
Decrease work of heart
Variant Angina
Spasm in main coronary artery
Chest pain even at rest
Aim of treatment in Variant Angina
Dilation of coronary artery
Drugs used in Angina
Nitrates
Calcium channel blockers
Potassium channel openers
Beta blockers
Nitrates are metabolized to NO by which enzyme
Aldehyde dehydrogenase
Nitrates acts by increasing
cGMP levels - which further stimulates Protein kinase a - activate MLCK - Leads to smooth muscle relaxation (Vasodilation)
Nitrates include which drugs
Glyceryl trinitrate
Isosorbide dinitrate
Isosorbide mononitrate
Pentaerythrital tetranitrate
Amyl nitrite
Nitrates which can be given sublingually, used in acute attack of Angina (DOC)
NTG
Isosorbide dinitrate
Which nitrate have minimum first pass metabolism
Isosorbide mononitrate
Longest acting Nitrate
Pentaerythrital tetranitrate
Shortest acting nitrate
Amyl nitrite
Nitrate free period should be atleast
6-8 hours
Can show tolerance if remains 24 hrs in blood
Uses of Nitrates
A - Angina
B - Biliary Colic
C - Cyanide Poisoning
D - Dil ka Daura (MI)
E - Esophageal spasm
F - Failure (CHF)
Which nitrate can convert Hb to Methb and can reverse Cyanide Poisoning
Amyl nitrite + Sodium Thiosulfate to convert CyanmetHb to Sodium thiocyanate - passes from urine
Preferred antidote for Cyanide Posioning
Iv Hydroxycobalamin
Which drugs if given with Nitrates can cause severe Hypotension
Sildenafil
Tadalafil - PDE Inhibitors - can leads to high level of cGMP - Vasodilation
Calcium channel blockers used in Angina
Verapamil
Diltiazem
DHPs
Action of Verapamil and Diltiazem in Angina
Decreases preload nd Afterload
Decreases HR
Action of DHPs in Angina
Can cause tachycardia and can precipitates Angina
Normally not preferred
Side effects of Calcium channel blockers
Headache
Constipation
Gum hypertrophy
Drugs of Dihydropyridines(DHPs) group
Nifedipine
Clevidipine
Nimodipine
Nicardipine
Amlodipine
Clenidipine
Which DHPs are contraindicated in Anginal patients
Nifedipine
Clevidipine - Shortest acting
Which DHP is Cerebroselective and used in Subarachnoid hemorrhage
Nimodipine
DOC in Hypertensive emergencies
Long acting DHPs
Nicardipine
Amlodipine
Potassium channel openers used in Angina
Releases NO
NICORANDIL
Action of beta blockers in Angina
Decreases HR
contraindicated in Variant Angina
Which drugs show Coronary steal Phenomenon
Vasodilation of only small coronary arteries
H - Hydralazine
I - Isoflurane
D - Dipyridamole
E - Enflurane
Bradycardiac agent that can be used in Angina
Ivabradine
Rho kinase inhibitor which is approved for angina
Fasudil
Metabolic modulators mechanism of action in Angina
Inhibits Fatty acid oxidation and let use glucose instead of fatty acids
Metabolic modulators drugs used in Angina
Trimetazidine
Ranolazine - mainly acts as Na+ channel blocker
Characteristics of Myocardial Infarction
Severe pain
Long duration
Other associated symptoms
Treatment of STEMI
S - Streptokinase
O - O2
N - Nitrate
A - Aspirin
M - Morphine
Drugs used in NSTEMI
M - Morphine
O - O2
N - Nitrates
A - Aspirin
