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Drugs > Elm 12 Stable Angina > Flashcards

Elm 12 Stable Angina Flashcards

1
Q

Q: What is the main cause of chest pain in both angina and acute coronary syndrome (ACS)?

A

A: Cardiac ischemia.

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2
Q

Q: How does stable angina differ from ACS in terms of pain resolution?

A

A: Stable angina resolves with rest after a few minutes, while ACS does not resolve quickly or with rest.

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3
Q

Q: List the types of acute coronary syndrome from most to least harmful.

A

A: Unstable angina, non-ST elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction.

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4
Q

Q: What causes the chest pain associated with angina pectoris?

A

A: Cardiac ischemia leads to the release of pain mediators like protons, potassium, and adenosine, which signal to the CNS.

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5
Q

Q: Why is chest pain from the heart often interpreted vaguely by the body?

A

A: Because pain from the heart is unusual, the body interprets it vaguely, causing general chest pain.

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6
Q

Q: What are the four types of angina?

A

A: Stable angina, unstable angina, Prinzmetal’s angina, microvascular angina.

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7
Q

Q: What triggers stable angina, and how can it be relieved?

A

A: Triggers include exercise, excitement, and cold weather. It can be relieved by rest.

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8
Q

Q: What causes unstable angina, and why is it more serious?

A

A: Caused by atherosclerosis and a blood clot. It is more serious because it is unpredictable, cannot be relieved by rest, and may progress to myocardial infarction.

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9
Q

Q: How can angina be treated?

A

A: By reducing oxygen demand or increasing oxygen supply to the heart.

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10
Q

Q: What is the initial treatment recommended by NICE for angina?

A

A: Aspirin to prevent platelet aggregation and statins to lower LDL and prevent plaque worsening.

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11
Q

Q: Name some drugs used to treat angina.

A

A: Organic nitrates, beta blockers, calcium channel blockers, potassium channel activators.

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12
Q

Q: What is first pass metabolism?

A

A: It is when a drug is absorbed by the gut into the hepatic portal vein and taken to the liver, where much of it is detoxified, reducing the bioavailability of the drug.

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13
Q

Q: Why can’t drugs susceptible to first pass metabolism be taken orally?

A

A: Because they lose a significant amount of their effectiveness when processed by the liver.

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14
Q

Q: What are alternative routes of administration for drugs susceptible to first pass metabolism?

A

A: Topical/transdermal application, parenteral routes (injection), and mucus membrane routes (mouth sprays, vaginal, under the tongue).

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15
Q

Q: What was glyceryl trinitrate (GTN) originally used for?

A

A: It was used to make explosives.

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16
Q

Q: Who discovered the vasodilatory action of nitroglycerine?

A

A: Sobrero discovered it when he experienced headaches from handling nitroglycerine.

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17
Q

Q: Who first used amyl nitrite to treat angina, prompting the use of nitroglycerine for the same purpose?

A

A: Brunton used amyl nitrite to treat angina, prompting Murrell to use nitroglycerine.

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18
Q

Q: Why is the name GTN used instead of nitroglycerine?

A

A: Because of its high association with explosives.

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19
Q

Q: In what forms can GTN be administered to relieve acute angina?

A

A: GTN can be administered sublingually (injection), buccally (mouth spray), or as a patch.

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20
Q

Q: How long do the effects of GTN last for relieving acute angina?

A

A: The effects last for 20-30 minutes.

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21
Q

Q: What is a key characteristic of organic nitrates like GTN in terms of their activation?

A

A: They are prodrugs that need to be metabolized at the site of action (vasculature or heart).

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22
Q

Q: What is the active form of organic nitrates, and how is it produced?

A

A: The active form is nitric oxide (NO), produced through metabolism.

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23
Q

Q: How does NO (nitric oxide) work to cause vasodilation?

A

A: NO activates guanylyl cyclase, which converts GTP to cGMP, leading to reduced calcium concentration and vasodilation.

24
Q

Q: What is the main mechanism by which organic nitrates provide relief from angina?

A

A: By reducing cardiac work and thus reducing cardiac oxygen demand.

25
Q

Q: How do organic nitrates reduce cardiac workload via venous effects?

A

A: They dilate capacitance veins, reducing central venous pressure, venous return, end diastolic volume (EDV), and end diastolic pressure (EDP), which reduces myocardial stretch, contractile force, and stroke volume.

26
Q

Q: How do large doses of nitrates reduce cardiac workload through arteriolar effects?

A

A: They cause arteriolar dilation, reducing peripheral resistance and cardiac afterload.

27
Q

Q: How do organic nitrates improve coronary blood supply?

A

A: By dilating collateral vessels, allowing more blood flow around blocked vessels.

28
Q

Q: What was the contribution of Murrell to the treatment of angina?

A

A: Murrell was prompted by Brunton’s use of amyl nitrite to use nitroglycerine to treat angina.

29
Q

Q: What other names are organic nitrates known by in medical treatments?

A

A: Isosorbide dinitrate and nicorandil are examples of other organic nitrates.

30
Q

Q: Name two long-acting nitrates used to treat angina.

A

A: Isosorbide mononitrate and isosorbide dinitrate.

31
Q

Q: How are long-acting nitrates like isosorbide mononitrate and dinitrate administered?

A

A: They are effective when swallowed and can be given as tablets, sustained-release tablets, sublingual tablets, buccal sprays, transdermal patches, and IV injections.

32
Q

Q: What is a common side effect of nitrates due to cranial nerve dilation?

A

A: Throbbing headache.

33
Q

Q: How can tolerance to nitrates be minimized?

A

A: By spacing the doses correctly.

34
Q

Q: What are some side effects of nitrates?

A

A: Flushing of the skin, throbbing headache, postural hypotension, and reflex tachycardia.

35
Q

Q: How does nicorandil work in treating angina?

A

A: It activates K+ATP channels and acts as an NO donor, dilating both arteries and veins.

36
Q

Q: What are some side effects of nicorandil?

A

A: Headache, flushing, hypotension, nausea, and vomiting.

37
Q

Q: How do beta blockers help reduce angina symptoms?

A

A: They act on the sinoatrial node (SAN) to slow the heart rate, reducing oxygen demand and cardiac workload.

38
Q

Q: What type of drug is verapamil and how does it work?

A

A: Verapamil is a calcium channel blocker (CCB) that blocks L-type calcium channels, reducing heart rate and cardiac output, and dilating arterioles to reduce cardiac afterload.

39
Q

Q: What is verapamil used to treat?

A

A: Stable angina.

40
Q

Q: How does amlodipine differ from verapamil in terms of selectivity?

A

A: Amlodipine is vascular selective, more potent on vascular smooth muscle, and dilates arterioles and capacitance veins, reducing cardiac afterload and preload.

41
Q

Q: What is the overall effect of amlodipine on the heart?

A

A: It reduces cardiac work and oxygen demand.

42
Q

Q: What mechanism allows nitrates to reduce cardiac workload?

A

A: Nitrates reduce cardiac workload by dilating capacitance veins, reducing venous return, end diastolic volume, and pressure, thereby decreasing myocardial stretch and contractile force.

43
Q

Q: What is the purpose of coronary artery angioplasty?

A

A: To open blocked coronary arteries and insert a stent to keep them open, improving blood flow to the heart.

44
Q

Q: How is the catheter guided to the blocked coronary artery during angioplasty?

A

A: By injecting a radio-opaque dye and using an X-ray machine to visualize its path.

45
Q

Q: What is the function of the balloon tip on the catheter during angioplasty?

A

A: It inflates to open the blocked artery and deploy the stent.

46
Q

Q: What types of stents can be used in coronary artery angioplasty?

A

A: Bare stainless steel stents or drug-eluting stents that reduce inflammation.

47
Q

Q: When is coronary artery angioplasty typically used?

A

A: For treating angina not controlled by drugs and as emergency treatment for heart attacks.

48
Q

Q: Does coronary artery angioplasty reduce the risk of future heart attacks or death?

A

A: No, it improves symptom control but does not reduce the risk of future heart attacks or death.

49
Q

Q: What are some side effects of coronary artery angioplasty?

A

A: Stroke, myocardial infarction, cognitive decline, and restenosis (re-closing) of the artery.

50
Q

Q: What is coronary artery bypass graft (CABG) surgery?

A

A: A procedure that uses a non-essential blood vessel from another part of the body to bypass a blocked coronary artery.

51
Q

Q: Which blood vessels are commonly used in CABG surgery?

A

A: The internal mammary artery and the great saphenous vein.

52
Q

Q: What determines whether a CABG is termed a single, double, or triple bypass?

A

A: The number of new connections made to bypass blocked arteries.

53
Q

Q: When is CABG surgery typically performed?

A

A: When drug treatment is ineffective and the blockage cannot be reached with a stent.

54
Q

Q: Does CABG surgery improve survival in high-risk patients?

A

A: Yes, it improves survival in high-risk patients.

55
Q

Q: Does CABG surgery reduce the risk of a second heart attack?

A

A: No, it does not reduce the risk of a second heart attack.

56
Q

Q: What are some surgical side effects of CABG surgery?

A

A: Poor wound healing, blood loss, and dysrhythmias.

57
Q

Q: What other complications can arise from CABG surgery?

A

A: Myocardial infarction, stroke, cognitive decline, and the need for repeated surgery as grafts may need to be replaced after up to 15 years.

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