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CVS Pharmacology > Drugs for Ischaemic Heart Disease > Flashcards

Drugs for Ischaemic Heart Disease Flashcards

1
Q

What is angina pectoris?

A

Chest pain caused by insufficient coronary blood flow to meet the oxygen demands of the myocardium.

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2
Q

Name three types of angina.

A
  1. Atherosclerotic angina
  2. Vasospastic angina
  3. Unstable angina
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3
Q

What are the main principles of treatment of ischaemic heart disease?

A

Increase myocardial oxygen supply and/or decrease myocardial oxygen demand.

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4
Q

What are the four factors affecting cardiac oxygen demand?

A
  1. Preload (determined by blood volume and venous tone)
  2. Heart rate
  3. Afterload (determined by BP)
  4. Cardiac contractility
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5
Q

What are the four classes of drugs used for IHD?

A
  1. Nitrates
  2. Calcium channel blockers
  3. Beta blockers
  4. Ivabradine
    *Anti-platelets and cholesterol lowering drugs also used
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6
Q

How do nitrates affect smooth muscle?

A

Nitrates act as NO donors, increasing the activity of guanylyl cyclase which catalyses the conversion of GTP to cGMP. Increased cGMP acts on the myosin light chain to cause smooth muscle relaxation.

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7
Q

MOA of nitrates?

A
  1. Venodilation decreases venous return and preload
  2. Arteriolar dilation decreases afterload
    thus decreasing oxygen consumption.
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7
Q

How does the activity of the different glycerol nitrates compare?

A

Nitroglycerin (glyceryl trinitrate) and the dinitrate both cause significant vasodilation. Mononitrate is less active.

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8
Q

What are the modes of administration of nitroglycerin?

A

Sublingual and transdermal.

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9
Q

What is the onset and duration of action for the sublingual form of nitroglycerin?

A

1-5 min; 10-30 min (for acute treatment)

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10
Q

What is the onset and duration of action for the transdermal form of nitroglycerin?

A

30-60 min; 7-10 h (prophylaxis)

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11
Q

How is isosorbide mononitrate administered?

A

Orally.

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12
Q

What is the onset and duration of action for isosorbide mononitrate?

A

30-45 min; 6h (IR) and 12 - 24h (SR), used as prophylaxis.

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13
Q

MOA of isosorbide mononitrate?

A
  1. At low plasma conc., causes venous dilatation, peripheral pooling, decrease venous return and reduction in preload
  2. At high plasma conc., arterial dilation, decreases systemic vascular resistance and arterial pressure, decreasing afterload
  3. Decreases end diastolic volume and pressure, lowers intramural pressure, direct dilatory effect on coronary arteries, improves subendocardial blood flow
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14
Q

Name three adverse effects of nitrates.

A
  1. Reflex tachycardia (due to baroreflex)
  2. Hypotension (due to venodilation)
  3. Headache (meningeal artery vasodilation)
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15
Q

MOA of beta blockers for IHD?

A

Decrease heart rate and contractility thus reducing cardiac oxygen requirements.

16
Q

What are the two types of Ca channel blockers?

A

Dihydropyridines (DHP) and non-DHP

17
Q

Name two non-DHP Ca channel blockers.

A

Verapamil, diltiazem.

18
Q

Name two DHP Ca channel blockers.

A

Nifedipine, amlodipine.

19
Q

MOA of non-DHP Ca channel blockers.

A

Decreased Ca2+ levels leads to inhibition of the SA and AV nodes (AV block), thus reducing heart rate.

20
Q

MOA of DHP Ca channel blockers.

A

Decreased Ca2+ levels leads to decreased calcium-induced calcium release, resulting in decreased myocardial contractility (decreased Ca-calmodulin complex formation, decreased activation of myosin light chain kinase, decreased myosin light chain and actin binding) and reduction in vascular smooth muscle tone and BP (decreased afterload)

21
Q

How do the Ca channel blockers compare in terms of BP lowering?

A

Verapamil=diltiazem=nifedipine

22
Q

How do the Ca channel blockers compare in terms of vasodilatory effect?

A

Nifedipine > diltiazem > verapamil

23
Q

How do the Ca channel blockers compare in terms of cardiodepressant effect?

A

Verapamil > Nifedipine > Diltiazem

24
Q

Name the adverse effects of Ca channel blockers.

A

Cardiac depression: bradycardia, AV blocker, heart failure

25
Q

Name three clinical uses of DHP Ca channel blockers.

A
  1. Hypertension
  2. Stable angina (amlodipine)
  3. Myocardial infarction and stroke prevention (amlodipine)
26
Q

Name three adverse effects of DHP Ca channel blockers.

A
  1. Hypotension
  2. Heart failure
  3. Myocardial infarction

CVS Pharmacology (3 decks)

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