Ischaemic Heart Disease Drugs Flashcards
describe angina pain
heavy, retrosternal chest tightness, LHS, radiates to left side and jaw
what is angina pain associated with
breathlessness
what are the co-morbidities of angina
diabetes mellitus (as get neuropathy that masks symptoms), previous MI, COPD
what is GTN
glyceryl trinitrate, a form of nitrate
what is GTN available as and what is a side effect
tablets and sprays (sublingual), patches
fainting, headaches and tolerance
what drugs can be used to treat angina
beta blockers, calcium channel blockers, potassium ATP channel activators, long acting nitrates, ivabradine, ranolazine
statins, aspirin, ACE inhibitors
how does GTN help angina
acts as venodilator, minor coronary vasodilating effect
how do nitrates help angina
nitric oxide donors, act directly on the vascular smooth muscle to produce venous and arterial dilatation,
reducing pre-load, after-load and oxygen demand.
how do beta blockers help angina
improve oxygen supply and demand balance by reducing heart rate and blood
pressure, decreasing end systolic stress and contractility and prolonging diastole, allowing more
coronary flow. Act on beta 1 adrenoceptors in heart which mediate inotropic effects and chronotropic effects.
how do calcium channel blockers help angina
inhibit calcium transport and induce smooth muscle relaxation.
what drugs increases vagal tone
digoxin
how does ivabrodine help angina
reduces heart rate by inhibitor funny current channels
give an example of a non selective beta blocker
propanolol
give an example of a B1 selective beta blocker
atenolol, bisoprolol
name two calcium channel blockers
Verapamil, diltiazem
what are the side effects of calcium channel blockers
ankle oedema, arrhythmias (bradycardia and heart block)
what is dihydropyridine
vasodilating calcium channel blocker
what type of patients benefit from ivabrodine
those who aren’t cured/ cant use beta blockers (asthmatics)
what causes stable angina to become unstable
rupture of plaque in coronary artery
what is nicorandil
vasodilatory drug used to treat angina, causes severe ulcers as SE
what is ranolazine
drugs which acts metabolically to reduce the workload of the heart, used in angina (late sodium channel mediator)
what can an ST depression suggest
myocardial ischaemia
in what lead should the R wave be tallest
lead 2
what does a tallest r wave in lead 1 mean
deviated to the left axis
what does a tallest r wave in lead 3 mean
right axis deviation
describe ST elevation in MI
(STEMI) in V1-4, anteroseptal ST elevation (tombstoning elevation)
what is troponin
protein released into bloodstream during heart attack, indicate damage to the myocardium
what does persistent ST elevation suggest when associated with heart pain
STEMI
what does ST abnormalities with normal troponin and heart pain mean
unstable angina
what does a normal ECG with rise/fall in troponin and chest pain suggest
NSTEMI
what is used to treat a NSTEMI
(keep blood very thin)
aspirin, pain relief, O2, clopidogrel, fondaparinux, beta blocker, IV GTN, Glycoprotein IIB/IIIA inhibitor
how does aspirin help in a NSTEMI
inhibits thromboxane (antiplatelets)(cox1 inhibitor)
what is the side effect of aspirin
GI bleeding
what is the conservative approach to treating NSTEMI
asymptomatic patients are given several days for plaque to stabilise, exercise testing performed, catherterised if symptoms persist
describe the early invasive approach to NSTEMI
intensive medical regime with more widespread use of clopidogrel and IIB/IIIA
prompt catheteristion with subsequent revascularisation
what is intermittent claudication
cramping in legs when exercise caused by atherosclerosis in peripheral arteries
what effect do beta blockers have on intermittent claudication
can worsen it as blocks dilation of vessels in skeletal muscles during exercise
what drugs could be used to treat intermittent claudication if nitrates causing headaches
calcium channel blocker or ivabradine
what is a side effect of amoldipine
ankle oedema
what drug can replace amoldipine if that causes ankle oedema
nicorandil
what other symptoms does heart failure lead to
fatigue, SOB (congestion of the lungs), retention of fluid- peripheral oedema
what treatments should be given to someone in heart failure
digoxin, anticoagulants, ACE inhibitor, spironolactone, nitrates, aspirin
how does digoxin help heart failure
slows and strengthens heart contractions
how does spironolactone
prevents fluid retention
how does the body respond to the heart beating poorly and how is this resolved
releases catecholamines, hormones which activates symp system and RAAS, rising BP
stopped by Beta blockers, ACE inhibitors and ARBs (blood pressure)
why are anticoagulants required in atrial fibrillation
blood clots usually in left atrial appendage which can lead to stroke
Shortly after he is commenced on ACE inhibition his plasma creatinine concentration doubles, why?
Ace can worsen renal function
how can diuretics help heart failure
help get rid of unnecessary water and salt via urination
what diuretics are used to treat heart failure
spironolactone, furosemide etc
