Drugs for IHD Flashcards
Aims of drug treatment for IHD (Angina)
Want to decrease Pre-load, decrease Afterload and decrease oxygen consumption by the heart will increasing its Supply
What drugs target decreased preload
GTN
How does GTN work?
It will promote the activation of NOS to promote NO from arginine. NO will then travel to the Smooth muscle where it activates guanylate cyclase to convert GTP to cGMP. This will then promote the dephosphorylation of Myosin light chain kinase and promote relaxation of veins
How do Beta Blocker’s Work to improve O2 supply and reduce demand
They decrease contractiliy and reduce rate
How do Ca2+ dihydropyridines reduce afterload
The promote inhibition of the L-Type Ca2+ channels and hence promote vasodilation
Novel therapys
Ivabradine which acts on If Na+ channels, and has little side effects as there is no peripheral side effects such as contractility, relaxation, conduction, repolarisation and blood pressure, As a result then lifestyle choices are not restricted
How do non-specific Ca2+ channel blockers work
Decrease heart rate, decrease SV and decrease TPR
What are the 5 drug therapies given for immediate relief in IHD
Oxygen, morphine, Aspirin, Heparin, Anti-platelets and IV GTN
What are the drugs given for continual management of IHD
Beta blockers, ACEi/A2Ri, Aspirin and Statins
What are the three drugs that target ADP receptors on platelets
Clopidogrel, Prasugrel (STEMI) and Ticagrelor (NSTEMI)
What are the two drugs that target gp IIb/IIIa receptors on platelets
Aciximab (irreversible) and tirofiban (reversible)
What are the 8 complications of IHD
- Arrhytmias
○ Sudden death due to VT or VF
○ Bradycardia or Heart block
○ AF leading to Thrombi + stroke - RHF and LHF
- Pericarditis
- Aneurysm of LV
- Septal or LV rupture leading to tamponade
- Valve insufficiency due to papillae rupture (MR)
- Dissecting Aorta
- Pleural Effussions and Pulmonary Oedema
