ischaemic heart disease

Question 1

50 yr old. Chest and left arm feel heavy after he walks up a steep slope. Discomfort is relieved by 5 mins rest.
What drugs improve prognosis?

Answer 1

aspirin 75mg OD
clopidogrel 75mg OD (secondary treatment for pmts intolerant of aspirin)
statins 10-40mg OD

previous MI or co-existing HF:
beta blockers
ACEI

Question 2

50 yr old. Chest and left arm feel heavy after he walks up a steep slope. Discomfort is relieved by 5 mins rest.
What drugs relieve symptoms?

Answer 2

Glyceryl trinitrate - nitrovasodilator
Isosorbide mononitrate - prophylaxis of angina
Beta blockers - decrease pre& afterload, decrease rate, decrease contractility
Ca channel blockers

Question 3

Aspirin - what is the MOA

what are the SEs

Answer 3

irreversible inhibition of cyclooxygenase enzyme

Gastropathy

Question 4

Statin - SEs?

Answer 4

myositis- stop if CK>x10

hepatitis - stop is ALT >x3

Question 5

GTN - which is a common SE
diarrhoea
nausea
headache
hepatitis
pruritis

Answer 5

headache
flushing
hypotension

Question 6

Isosorbide mononitrate - what is the main problem
headache
n/v
bradycardia
tolerance
tiredness

Answer 6

tolerance

interaction with sildenafil

Question 7

beta blockers - what are common SEs

Answer 7

bronchospasm
tiredness
impotence 
bradycardia
worsening HF
cold extremities
hypotension

Question 8

Beta blockers
what do Beta 1 blockers do
examples..

Answer 8

cardiac - negatively inotropic and chronotropic
bisoprolol
metoprolol
atenolol

Question 9

Beta 2 blockers - what do they do

Answer 9

vascular and pulmonary effects - decrease BP through vasodilatation

Question 10

which is NOT a non selective beta blocker
timolol
metoprolol
propranolol
labetalol
sotalol

Answer 10

metoprolol

Question 11

Ca channel blockers block ca channels in myocardium & vasculature. they decrease HR, contractility and increase vasodilatation. 
Which 2 are not dihydropyridines?
verapamil
nifedipine
minodipine
diltiazem
amlopdipine
nicardipine

Answer 11

verapamil
diltiazem
(these are more useful for cardiac effects whereas amlodipine is more useful as a vasodilator)

Question 12

SEs of Ca Channel blockers

Answer 12

oedema 
headache
flushing
postural hypotension
aggravation of MI

Question 13

Severe retrosternal chest pain and nausea and sweating. ECG - ST elevation
What treatments should be given immediately

Answer 13

Aspirin 300mg
Morphine
Metoclopramide
Oxygen
PCI asap
ACE I
Statins
Beta blockers
Nitrate for pain
Clopidogrel 300mg - probably not

Question 14

Contraindications for PCI. Which is not a contraindication

recent CVA
GI haemorrhage
operations
hypertension
proliferative retinopathy
bleeding diathesis
Hx >8 hrs

Answer 14

Hx >24 hrs is a contraindication (not 8 hrs)

Question 15

NSTEMI management / UA

Answer 15

Aspirin 300mg
B blocker
Nitrate infusion for pain
LMWH
Statin
GpIIb/IIIb receptor blocker if high risk (abciximab, eptifibatide , tirofiban )
Clopidogrel - give if high risk (not for 2ndry prevention)
?Coronary angiogram