Ischaemic Heart Disease Drugs

Question 1

describe angina pain

Answer 1

heavy, retrosternal chest tightness, LHS, radiates to left side and jaw

Question 2

what is angina pain associated with

Answer 2

breathlessness

Question 3

what are the co-morbidities of angina

Answer 3

diabetes mellitus (as get neuropathy that masks symptoms), previous MI, COPD

Question 4

what is GTN

Answer 4

glyceryl trinitrate, a form of nitrate

Question 5

what is GTN available as and what is a side effect

Answer 5

tablets and sprays (sublingual), patches

fainting, headaches and tolerance

Question 6

what drugs can be used to treat angina

Answer 6

beta blockers, calcium channel blockers, potassium ATP channel activators, long acting nitrates, ivabradine, ranolazine

statins, aspirin, ACE inhibitors

Question 7

how does GTN help angina

Answer 7

acts as venodilator, minor coronary vasodilating effect

Question 8

how do nitrates help angina

Answer 8

nitric oxide donors, act directly on the vascular smooth muscle to produce venous and arterial dilatation,
reducing pre-load, after-load and oxygen demand.

Question 9

how do beta blockers help angina

Answer 9

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.

Question 10

how do calcium channel blockers help angina

Answer 10

inhibit calcium transport and induce smooth muscle relaxation.

Question 11

what drugs increases vagal tone

Answer 11

digoxin

Question 12

how does ivabrodine help angina

Answer 12

reduces heart rate by inhibitor funny current channels

Question 13

give an example of a non selective beta blocker

Answer 13

propanolol

Question 14

give an example of a B1 selective beta blocker

Answer 14

atenolol, bisoprolol

Question 15

name two calcium channel blockers

Answer 15

Verapamil, diltiazem

Question 16

what are the side effects of calcium channel blockers

Answer 16

ankle oedema, arrhythmias (bradycardia and heart block)

Question 17

what is dihydropyridine

Answer 17

vasodilating calcium channel blocker

Question 18

what type of patients benefit from ivabrodine

Answer 18

those who aren’t cured/ cant use beta blockers (asthmatics)

Question 19

what causes stable angina to become unstable

Answer 19

rupture of plaque in coronary artery

Question 20

what is nicorandil

Answer 20

vasodilatory drug used to treat angina, causes severe ulcers as SE

Question 21

what is ranolazine

Answer 21

drugs which acts metabolically to reduce the workload of the heart, used in angina (late sodium channel mediator)

Question 22

what can an ST depression suggest

Answer 22

myocardial ischaemia

Question 23

in what lead should the R wave be tallest

Answer 23

lead 2

Question 24

what does a tallest r wave in lead 1 mean

Answer 24

deviated to the left axis

Question 25

what does a tallest r wave in lead 3 mean

Answer 25

right axis deviation

Question 26

describe ST elevation in MI

Answer 26

(STEMI) in V1-4, anteroseptal ST elevation (tombstoning elevation)

Question 27

what is troponin

Answer 27

protein released into bloodstream during heart attack, indicate damage to the myocardium

Question 28

what does persistent ST elevation suggest when associated with heart pain

Answer 28

STEMI

Question 29

what does ST abnormalities with normal troponin and heart pain mean

Answer 29

unstable angina

Question 30

what does a normal ECG with rise/fall in troponin and chest pain suggest

Answer 30

NSTEMI

Question 31

what is used to treat a NSTEMI

Answer 31

(keep blood very thin) aspirin, pain relief, O2, clopidogrel, fondaparinux, beta blocker, IV GTN, Glycoprotein IIB/IIIA inhibitor

Question 32

how does aspirin help in a NSTEMI

Answer 32

inhibits thromboxane (antiplatelets)(cox1 inhibitor)

Question 33

what is the side effect of aspirin

Answer 33

GI bleeding

Question 34

what is the conservative approach to treating NSTEMI

Answer 34

asymptomatic patients are given several days for plaque to stabilise, exercise testing performed, catherterised if symptoms persist

Question 35

describe the early invasive approach to NSTEMI

Answer 35

intensive medical regime with more widespread use of clopidogrel and IIB/IIIA prompt catheteristion with subsequent revascularisation

Question 36

what is intermittent claudication

Answer 36

cramping in legs when exercise caused by atherosclerosis in peripheral arteries

Question 37

what effect do beta blockers have on intermittent claudication

Answer 37

can worsen it as blocks dilation of vessels in skeletal muscles during exercise

Question 38

what drugs could be used to treat intermittent claudication if nitrates causing headaches

Answer 38

calcium channel blocker or ivabradine

Question 39

what is a side effect of amoldipine

Answer 39

ankle oedema

Question 40

what drug can replace amoldipine if that causes ankle oedema

Answer 40

nicorandil

Question 41

what other symptoms does heart failure lead to

Answer 41

fatigue, SOB (congestion of the lungs), retention of fluid- peripheral oedema

Question 42

what treatments should be given to someone in heart failure

Answer 42

digoxin, anticoagulants, ACE inhibitor, spironolactone, nitrates, aspirin

Question 43

how does digoxin help heart failure

Answer 43

slows and strengthens heart contractions

Question 44

how does spironolactone

Answer 44

prevents fluid retention

Question 45

how does the body respond to the heart beating poorly and how is this resolved

Answer 45

releases catecholamines, hormones which activates symp system and RAAS, rising BP stopped by Beta blockers, ACE inhibitors and ARBs (blood pressure)

Question 46

why are anticoagulants required in atrial fibrillation

Answer 46

blood clots usually in left atrial appendage which can lead to stroke

Question 47

Shortly after he is commenced on ACE inhibition his plasma creatinine concentration doubles, why?

Answer 47

Ace can worsen renal function

Question 48

how can diuretics help heart failure

Answer 48

help get rid of unnecessary water and salt via urination

Question 49

what diuretics are used to treat heart failure

Answer 49

spironolactone, furosemide etc