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Drugs for Ischaemic Heart Disease Flashcards

1
Q

Name the 3 types / effects of anti-anginal drugs

A
  1. Vasodilation
  2. Cardiac depression
  3. Cardiac pacemaker retardation
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2
Q

Name the 4 classes of drugs to treat angina

A
  1. Nitrates
  2. Calcium channel blockers
  3. Beta blockers
  4. Ivabradine
    *antiplatelets and cholesterol lowering drugs can also be used
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3
Q

MOA of nitrates

A

Source of NO which activates guanylyl cyclase which increases conversion of GTP to cGMP.
Increased cGMP leads to increased deactivation of myosin LC thus increases vasorelaxation

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4
Q

Outline how nitrate induced vasorelaxation leads to anti-angina effect

A

Vasorelaxation constitutes both venodilation and arteriolar dilation
Venodilation: results in decreased preload
Arteriolar dilation: results in decreased after load
Both will decrease oxygen consumption, thus is a therapy for angina

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5
Q

State 2 common nitrates

A
  1. Nitroglycerin (glyceryl trinitrate)
  2. Isosorbide dinitrate (ISDN)
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6
Q

State the 2 routes of administration for nitroglycerin

A
  1. Sublingual
  2. Transdermal
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7
Q

Advantage of sublingual administration of nitroglycerin

A

Absorbed very quickly so faster onset of action and duration of action

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8
Q

Clinical use of nitroglycerin

A

Acute treatment for angina pectoris

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9
Q

Mode of administration for ISDN / ISMN

A

Oral

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10
Q

Clinical use of ISDN / ISMN

A

Angina pectoris prophylaxis
Can also be used for heart failure

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11
Q

Besides reducing preload and afterload, ISDN / ISMN also has an additional effect on the coronary arteries.
What is the effect and what’s the result of it?

A

Additional direct dilatory effect on the coronary arteries
Results in decreased intramural pressure, which improves subendocardial blood flow

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12
Q

3 ADRs of nitrates

A
  1. Reflex tachycardia
  2. Hypotension
  3. Headache
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13
Q

Physiological basis for reflex tachycardia in nitrate use

A

Vasorelaxation causing baroreceptor reflex

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14
Q

Physiological basis for hypotension in nitrate use

A

Vasorelaxation causing venodilation

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15
Q

Physiological basis for headache in nitrate use

A

Vasorelaxation causing meningeal artery vasodilation

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16
Q

Name the 2 generic types of calcium channel blockers

A
  1. Dihydropyridine (DHP) CCB
  2. Non DHP CCB
17
Q

Name the 3 types of cardiac disorders calcium channel blockers are used for, and for each, state whether it is the DHP or non-DHP form being used

A
  1. Antiarrythmic: non-DHP
  2. Antiangina: Both
  3. Antihypertensive: DHP
18
Q

State 2 examples of non-DHP calcium channel blocker drugs

A
  1. Verapamil
  2. Diltiazem
19
Q

State 2 examples of DHP calcium channel blocker drugs

A
  1. Nifedipine
  2. Amlodipine
20
Q

How do non-DHP calcium channel blockers work as an antiarrythmic

A

Reduce firing of SA and IV node causing decreased supra ventricular reentry tachycardia thus antiarrythmia

21
Q

How do calcium channel blockers work as an antiangina

A

Reduced myocardial contractility thus decreasing oxygen requirement

22
Q

How do DHP calcium channel blockers work as an antihypertensive

A

Reduced myocardial contractility causes reduced cardiac output thus lowering BP
Also causes decreased vascular smooth muscle tone thus lowering BP

23
Q

Adverse effect of all calcium channel blockers

A

Cardiac depression: bradycardia, AV node block, heart failure

24
Q

State 3 clinical uses of DHP calcium channel blockers

A
  1. Hypertension
  2. Stable angina (amlodipine)
  3. Reduce risk of myocardial infarction and stroke (amlodipine)
25
Q

State ADRs of DHP calcium channel blockers use

A
  1. Hypotension
  2. Heart failure
  3. Myocardial infarction
26
Q

MOA of ivabradine

A

Pure heart rate lowering drug.
Works by inhibiting the cardiac pacemaker I(f) current that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate.
Results in reduced cardiac workload and thus reduced oxygen consumption

27
Q

Clinical indication for ivabradine

A

Stable angina pectoris

28
Q

State 2 ADRs of ivabradine use

A
  1. Visual problems: luminal phenomena: transient enhanced brightness in a limited visual field
  2. Bradycardia symptoms: dizziness, hypotension, fatigue, malaise
29
Q

Name 2 concomitant diseases in a hypertensive patient, where beta blockers cannot be used

A
  1. Asthma
  2. Diabetes
30
Q

Of the 4 first line hypertensives, which cannot be used in a patient with congestive heart failure

A

Calcium channel blockers

31
Q

Of the 4 first line hypertensives, which cannot be used in a pregnant patient and why?

A

ACE-I / ARBs
Possible teratogen

CVS Pharmaco (6 decks)

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