IHD Flashcards
What happens in angina pectoris
Less severe ischemia and no muscle death - stable angina
What happens in MI
Death to muscle cells
Types of angina
- Stable angina (demand ischemia)
- Unstable angina (supply ischemia- thrombus)
- variant angina (prinzmetal/vasospastic)
What causes stable angina
Caused by 4Es ( exertion, emotional stress, exposure to cold/hot weather and eating heavy metal)
When does unstable angina occur
Occurs at rest or with limited physical activity
When does variant angina occur
Occurs at rest, pain at the same day with ST segment elevation and ventricular arrhythmias
What’s first line for angina relief
Short acting nitrates + B blockers or CCB to lower heart rate
- give CCB-DHP if heart rate is already low
How to prevent angina events
- Life style management and control risk factors
- also aspirin, statins and consider ACE I or ARBS
List the anti anginal drugs
- organic nitrates
- CCBs
- B blockers
List organic nitrates
Nitroglycerin And Isosorbide dinitrate -> fast duration for angina pain
Isosorbide mononitrate
Organic nitrates mechanism of action
Relax vascular smooth muscles by intracellular conversion to nitrate ions then to NO -> increases CGMP -> relaxation
Which vessels are dilated with low dose of organic nitrates
Veins
Which vessels are dilated at higher doses of organic nitrates
Arteries and arterioles
Nitroglycerin mode is administration
Sublingual -> rapid action
Give 3 doses of spray or 3 sublingual tablet during 15 mins
Nitroglycerin adverse effects
Postural hypotension tension
Nitroglycerin contraindications
Contraindicated with sildenafil as it causes hypotension
What is Monday disease
Tolerance to organic nitrates
What’s the best drug for variant angina
CCB
List CCB DHP
nifedipine and amlodipine (work on blood vessels)—> decrease after load
List CCB NON DHP
Diltiazem and verapamil -> work on blood vessels and heart
Which CCB is used in IHD
DHP and NON DHP
Which CCB is used in arrhythmias
NON DHP (arterial tachycardia)
Which CCB is used in hypertension
DHP
Which drug is contraindicated in variant angina
B blockers
Which drugs are contraindicated in 2nd and 3rd AV blocK and why
NON DHP and B blockers
They both have an effect on the heart
Allowed drug combos
Nitrates + CCB/B blockers
B Blockers + DHP
Which drug combos are not allowed
B blockers + NON DHP CCB
what is used to control heart rate
B blockers, CCBs and funny channel blockers
Anti platelet drugs for IHD
aspirin and clopidogrel
Which hyperlipidemia drugs are contraindicated in pregnant women
Statins
First line to decrease LDL
Statins
Statins mechanism of action
Inhibit HMG -CoA reductase
First line drug to decrease triglycerides
Fibrates and niacin
First line drug to increase HDL
Niacin and fibrates
Which statin is used in renal failure
Atorvastatin - longest half life
Which statins are used in liver failure
Pravastatin and Rosuvastatin
Statins adverse effects
Myopathy and rhabdomyolysis
What is ranolazine
Antianginal
