Ischemic heart Disease Drugs

Question 1

What are the risk factors for coronary heart diseases that are controllable?

Answer 1

Hypertension, high cholesterol, diabetes, smoking cigarettes, obesity

Question 2

What are the uncontrollable risk factors for CAD?

Answer 2

Age, gender (male), race and family hx

Question 3

Burning, squeezing or crushing chest pain radiates to the left arm, shoulder or jaw is caused by?

And when does it occur?

Answer 3

Angina pectoris

Occurs mostly after physical exertion

Question 4

What is seen on the ecg of angina pectoris?

Answer 4

ECG ST segment depression or can be a normal ecg

Question 5

Chest pain after strenuous physical activity is what class?

Answer 5

1

Question 6

Chest pain after walking >2 blocks or climbing >1 flight of stairs is what class?

Answer 6

Class 2

Question 7

Chest pain when walking 1 or 2 blocks or climbing 1 flight of stairs is what class?

Answer 7

Class 3

Question 8

Chest pain at rest is caused by what class?

Answer 8

Class 4

Question 9

What is the mechanism of angina pectoris?

Answer 9

Chest pain due to decrease blood and oxygen supply to the heart

Question 10

Chest pain that occurs with exercise or stress and relieved by rest?

Answer 10

Stable angina

Question 11

Chest pain that occurs during rest and may progress to MI?

Answer 11

Unstable angina

Question 12

What causes vasospasm of coronary artery and shows a ST segment elevation during an attack?

How can you differentiate this from an ischemic heart(ex who is at risk)? And how are they treated?

Answer 12

Vasospastic angina (prinzmetal’s angina), because it occurs in females around 40-50. Usually occurs in a younger person. Give nitro prn if it is once a month

Question 13

What is the goal of treatment of angina and how will it be accomplished?

Answer 13

• To increase blood/ oxygen supply by lowering the vasospasm
• decreasing blood and oxygen demand by decreasing tpr, cardio output or both

Question 14

Drugs used to treat angina pectoris

Answer 14

Nitrates
Beta blockers
Calcium channel blockers Metabolic modifier Ivabradine

Question 15

How does the vasodilator nitrates work?
How?

Answer 15

Work by activation of Nitric Oxide (NO)
eNOS(endothelial nitric oxide synthase) can be activated by: Acetylcholine, histamine, bradykinin, and serotonin.
GTP———NO+++ Guanylyl cyclase——————c GMP Relaxation

How? By dephosphorylation of myosin light-chain which prevents its interaction with actin and causes relaxation of the blood vessels which leads to vasodilation.

Question 16

How Nitrates decreases cardiac oxygen demand?

Answer 16

Dilation of large veins lead to decrease preload and decrease cardia work (decrease oxygen demand)

Question 17

How Nitrates increase cardiac oxygen supply?

Answer 17

At high doses, nitrates cause arteriolar dilation (aorta) leading to decrease of afterload (increase oxygen supply)

Question 18

What are Other benefits of Nitrates:

Answer 18

Improve Collateral blood flow, Decrease coronary vasospasm, and Inhibits platelets aggregation

Question 19

What are the nitrates that are used clinically and how are they given?

Answer 19

Nitroglycerin given sublingual, po, transdermal and iv
Isosorbide given po

Question 20

What are the side effects of nitric oxide?

Answer 20

Headache, flushing,syncope, reflex tachycardia and edema
A, tachyphlaxis and acute tolerance

Question 21

What symptom occurs when you give amyloid nitrate? And what treats it?

Answer 21

Methemoglobinemia and methylene blue

Question 22

What is converted to cyanide and causes cyanide posioning?

Answer 22

Sodium nitroprusside

Question 23

What are the treatment of cyanide poisoning?

Answer 23

Amyl nitrite or sodium nitrite followed by sodium thisulfate and vitamin b12

Question 24

Patient on nitrates takes sadenfil or a pde5 inhibitor comes into the ER with chest pains. What is the effect of taking these two?

Answer 24

Severe hypotension

Question 25

What is the effect of taking beta blockers for angina?

Answer 25

They act directly on the heart and have no effect on blood vessels. They decrease the force of contraction, hr and co causes a decrease in oxygen demand

Question 26

What is contraindicated in Prinzmetal’s Angina?

Answer 26

Beta blockers because they keep alpha 1 open causing vasospasm

Question 27

What is the only drug proven to increase survival post MI?
*there are two specific drugs, what are they?

Answer 27

Beta blockers
Labetalol and Carvidelol

Question 28

Name the calcium channel blockers used in angina?

Answer 28

Amlodipine and nifedipine and nonhydropyridine: verapamil and diltiazem

Question 29

What dilates the coronary arteries and block Na and K and causes torsades de pointes?

Answer 29

Bepridil

Question 30

It blocks late inward Na+ current
No effect on blood pressure or HR
Contraindicated with antiarrhythmic drugs class I and III due to prolongation of QT interval

What is the drug?

Answer 30

Metabolic modifier:
Ranolazine

Question 31

What is the mechanism of action of ranolozine?

Answer 31

It blocks late inward Na+ current
No effect on blood pressure or HR

Question 32

What is ranolazine contraindicated too?

Answer 32

Contraindicated with antiarrhythmic drugs class I and III due to prolongation of QT interval

Question 33

Pt with chest pain with chronic heart failure with LVEF <35%

Answer 33

Ivabradine

Question 34

What is the mechanism of action of ivabradine?

Answer 34

Decreases heart rate by blocking the funny channels

Question 35

What would you give a patient that cannot tolerate beta blockers?

Answer 35

Ivabradine

Question 36

What are the side effects of Ivabradine?

Answer 36

Luminous phenomena, bradycardia and Av block

Question 37

Which of the following drugs is pivotal in Rx of Anginal Pectoris?
HCTZ Lisinopril Propranolol Nitroglycerin

Answer 37

Nitroglycerin