IHD

Question 1

What happens in angina pectoris

Answer 1

Less severe ischemia and no muscle death - stable angina

Question 2

What happens in MI

Answer 2

Death to muscle cells

Question 3

Types of angina

Answer 3

• Stable angina (demand ischemia)
• Unstable angina (supply ischemia- thrombus)
• variant angina (prinzmetal/vasospastic)

Question 4

What causes stable angina

Answer 4

Caused by 4Es ( exertion, emotional stress, exposure to cold/hot weather and eating heavy metal)

Question 5

When does unstable angina occur

Answer 5

Occurs at rest or with limited physical activity

Question 6

When does variant angina occur

Answer 6

Occurs at rest, pain at the same day with ST segment elevation and ventricular arrhythmias

Question 7

What’s first line for angina relief

Answer 7

Short acting nitrates + B blockers or CCB to lower heart rate
- give CCB-DHP if heart rate is already low

Question 8

How to prevent angina events

Answer 8

• Life style management and control risk factors

- also aspirin, statins and consider ACE I or ARBS

Question 9

List the anti anginal drugs

Answer 9

• organic nitrates
• CCBs
• B blockers

Question 10

List organic nitrates

Answer 10

Nitroglycerin And Isosorbide dinitrate -> fast duration for angina pain
Isosorbide mononitrate

Question 11

Organic nitrates mechanism of action

Answer 11

Relax vascular smooth muscles by intracellular conversion to nitrate ions then to NO -> increases CGMP -> relaxation

Question 12

Which vessels are dilated with low dose of organic nitrates

Answer 12

Veins

Question 13

Which vessels are dilated at higher doses of organic nitrates

Answer 13

Arteries and arterioles

Question 14

Nitroglycerin mode is administration

Answer 14

Sublingual -> rapid action

Give 3 doses of spray or 3 sublingual tablet during 15 mins

Question 15

Nitroglycerin adverse effects

Answer 15

Postural hypotension tension

Question 16

Nitroglycerin contraindications

Answer 16

Contraindicated with sildenafil as it causes hypotension

Question 17

What is Monday disease

Answer 17

Tolerance to organic nitrates

Question 18

What’s the best drug for variant angina

Answer 18

CCB

Question 19

List CCB DHP

Answer 19

nifedipine and amlodipine (work on blood vessels)—> decrease after load

Question 20

List CCB NON DHP

Answer 20

Diltiazem and verapamil -> work on blood vessels and heart

Question 21

Which CCB is used in IHD

Answer 21

DHP and NON DHP

Question 22

Which CCB is used in arrhythmias

Answer 22

NON DHP (arterial tachycardia)

Question 23

Which CCB is used in hypertension

Answer 23

DHP

Question 24

Which drug is contraindicated in variant angina

Answer 24

B blockers

Question 25

Which drugs are contraindicated in 2nd and 3rd AV blocK and why

Answer 25

NON DHP and B blockers

They both have an effect on the heart

Question 26

Allowed drug combos

Answer 26

Nitrates + CCB/B blockers

B Blockers + DHP

Question 27

Which drug combos are not allowed

Answer 27

B blockers + NON DHP CCB

Question 28

what is used to control heart rate

Answer 28

B blockers, CCBs and funny channel blockers

Question 29

Anti platelet drugs for IHD

Answer 29

aspirin and clopidogrel

Question 30

Which hyperlipidemia drugs are contraindicated in pregnant women

Answer 30

Statins

Question 31

First line to decrease LDL

Answer 31

Statins

Question 32

Statins mechanism of action

Answer 32

Inhibit HMG -CoA reductase

Question 33

First line drug to decrease triglycerides

Answer 33

Fibrates and niacin

Question 34

First line drug to increase HDL

Answer 34

Niacin and fibrates

Question 35

Which statin is used in renal failure

Answer 35

Atorvastatin - longest half life

Question 36

Which statins are used in liver failure

Answer 36

Pravastatin and Rosuvastatin

Question 37

Statins adverse effects

Answer 37

Myopathy and rhabdomyolysis

Question 38

What is ranolazine

Answer 38

Antianginal