ELM 7.2 Flashcards
Which of the followng disorders is caused by vasospasm of coronary arteries?
a. Acute coronary syndrome b. Prinzmetal's angina c. Stable angina d. Unstable angina
b
Stable and unstable anginas are caused by occlusion of an artery by atherosclerosis (plus a blood clot in unstable angina). ACS is an umbrella term for unstable angina, NSTEMI and STEMI.
Which is the first drug class in the NICE care pathway for acute stable angina?
a. beta blockers b. calcium channel blockers c. short acting organic nitrates d. long acting organic nitrates
c
Organic nitrates provide symptomatic relief of an angina attack. Beta blockers and calcium channel blockers are used to prevent further attacks
When are surgical options used to treat stable angina?
a. As a first line treatment b. If short acting organic nitrates do not work c. If beta blockers are insufficient to control the angina d. Only if drug treatments do not provide sufficient control
d
By which of the following routes of administration is a drug most likely to be broken down in first pass metabolism?
a. buccal b. intramuscular c. oral d. subcutaneous
c
When a drug is taken orally, it enters the circulation via the hepatic portal vein and is taken to the liver where it may be extensively metabolised (first-pass metabolism) before entering the the systemic circulation
What is the active principle of glyceryltrinitrate?
a. Glycerol b. Glycerylmononitrate c. Nitric oxide d. Nitrous oxide
c
Nitric oxide (NO) is an endogenous signalling molecule. It is produced by the breakdown of organic nitrates at their site of action (heart/vasculature).
Which of the following drugs is an organic nitrate available as a sustained release tablet for the treatment of angina?
a. dipyridamole b. glyceryltrinitrate c. isosorbide dinitrate d. verapamil
c
Isosorbide dinitrate (and the related compound isosorbide mononitrate) are used to treat angina. Unlike GTN, these drugs are available as a sustained release formulation. Verapamil is not an organic nitrate.
Select a use-dependent blocker of L-type calcium channels useful for treating stable angina:
a. nicorandil b. verapamil c. nifedipine d. flecainide
b
The key here is to take note of both bits of the stem. Nifedipine is a calcium channel blocker used to treat angina but is not use-dependent. Nicorandil is used to treat angina but is a nitrovasodilator and activator of KATP channels. Flecainide is a sodium channel blocker used as an antidysrhythmic agent.
Select an activator of KATP potassium channels that is used to treat angina:
a. glyceryl trinitrate b. isosorbide dinitrate c. diltiazem d. nicorandil
d
Nicorandil has two mechanisms of action. It is an organic nitrate (nitrovasodilator) but it also activates KATP channels. Both contribute to its antianginal actions. Isosorbide dinitrate and glyceryl trinitrate are nitrovasodilators whilst diltiazem is a calcium channel blocke
In this question there are three correct answers and one incorrect. Select the three correct options.
Which of the following anti-anginal drugs exert their effects principally through actions in blood vessels?
[mark all correct answers]
a.
amlodipine
b. atenolol c. glyceryltrinitrate d. isosorbide dinitrate
a, c, d
Atenolol works principally by slowing the heart and reducing force of contraction. The organic nitrates (GTN and isosorbide dinitrate) at on peripheral blood vessels and also improve coronary blood flow through collateral vessels. Amlodipine is a vasculature selective calcium channel blocker.
A small metal mesh tube designed to hold open a blocked coronary artery is known as a:
a. shunt b. catheter c. stent d. sleeve
c
Coronary artery stents are normally made of metal but more recently, stents have been constructed from polymers that can be absorbed by the body. Metal stents are often coated in a drug-eluting polymer that helps stop the vessel from becoming blocked again.
Which of the following blood vessels is frequently used in CABG procedures?
a. Internal iliac artery b. Internal mammary artery c. Femoral artery d. Radial artery
b
The other option is the great saphenous vein, from the leg. The femoral artery and radial artery are the normal “access points” for the catheter in coronary angioplasty
What does the abbreviation PCI stand for?
a. Preventative cardiac intubation b. Percutaneous coronary intervention c. Potential cardiac ischaemia d. Potassium chloride injection
b
PCI is another name for coronary angioplasty - it is “stenting” a coronary artery.
