drugs for ischaemic heart disease

Question 1

Nitrates MOA

Answer 1

• NO donor
• NO activates guanylyl cyclase
  -> GTP converted to cGMP
• > shifts myosin LC to become inactive hence relax

vasorelaxation
1. venodilation, dec preload
2. arteriolar dilation, dec afterload

=> dec oxygen consumption

Question 2

Name a nitrate for acute angina

Answer 2

1. nitroglycerin
   - used for acute treatment sublingually (within 1-5 min)

Question 3

Name a nitrate used as prophylaxis of angina pectoris

Answer 3

isosorbide dinitrate

Question 4

beta blockers

Answer 4

can be used to treat angina pectoris, same as anti hypertensives

Question 5

DHP calcium channel blockers MOA

Answer 5

• decrease intracellular [ca2+]
• prevents myosin LC from being activated by MLCK => relaxed myocytes
• myocardial contractility dec, oxygen requirement dec

=> antiangina

Question 6

Name DHP calcium blockers

Answer 6

1. nifedipine
2. amlodipine

Question 7

DHP calcium blockers clinical uses

Answer 7

1. angina pectoris
2. hypertension
3. reduce risk of myocardial infarction and stroke

Question 8

DHP calcium blockers adverse effects

Answer 8

1. hypotension
2. heart failure
3. myocardial infarction

Question 9

calcium channel blockers extent of vasodilation

Answer 9

nifedipine > diltiazem> verapamil

Question 10

calcium channel blockers extent of cardiac depressant

Answer 10

verapamil > diltiazem > nifedipine

Question 11

Ivabradine MOA

Answer 11

• inhibits cardiac pacemaker l(f) current that controls spontaneous diastolic depolarisation in the sinus node that regulates the heart rate
• reduce cardiac workload and myocardial o2 consumption

Question 12

ivabradine adverse effects

Answer 12

1. visual toxicity
2. dizziness due to bradycardia

Question 13

Nitrates adverse effect

Answer 13

Question 14

drug classes for IHD

Answer 14

1. nitrates
2. beta blockers
3. DHP calcium channel blockers
4. ivabradine