Lecture 13 and 14: Pharmacological treatment of IHD Flashcards
How is NO produced in the endothelial cells?
Ach, bradykinin or sheer stress increase Ca
Ca activates NOS which converts L-arg to NO
What is the definition fo stable angina?
A predictable pattern of pain during exercise that is relieved by rest
What are the side effects of nitrates?
Postural hypotension
Headache
Dizziness
Reflex tachycardia
How do nitrates work?
Increase NO which increases cGMP, reduces Ca and results in venodilation
How do beta blockers work?
Decrease frequency and force of contraction to decrease CO
Also inhibit RAAS by inhibiting renin release
What are the side effects of beta blockers?
Bronchoconstriction
Fatigue
Contraindicated in patients with peripheral vascular disease
What is the effect of dihydropyridines?
Dilate arterioles to decrease cardiac workload
What is the effect of phenylalkamines and benzodiazepines?
Decrease frequency and force of contraction to decrease cardiac workload
What are the side effects of ivabradine?
Luminous phenomena (Ih) in retina
Blurred vision
Dizziness
How does ivabradine work?
Blocks the pacemaker current (Ih/f) in the nodal tissue of the heart
What kind of drug is simvastatin?
Statin
How does prasugrel work?
P2Y12 inhibitor
blocks binding of ADP to ADPR on platelets
How does aspirin work?
COX inhibitor
Prevents further activation of platelets
What platelet receptor is activated when ADP binds the P2Y12 receptors.
GP2b/3a
What is the importance of GP2b/3a receptors?
Fibrinogen binds to these receptors to cross link different platelets.
What protein metabolises clopidogrel?
CYP2C19
What protein metabolises prasugrel?
CYP3A4
What are the signs of an MI?
Pain
Sweating
Tachycardia
Cold clammy skin
How does digoxin work?
Binds to the Na+/K+ ATPase and inhibits it - increases Na+ in heart - inhibits the Na+/Ca2+ exchanger - increased Ca2+ in muscle cell - stronger contraction
How does amioderone work?
K+ channel blocker that increases the refractory period of ventricular myocytes and can terminate arrhythmias
What is amioderone used to treat?
Dysrhythmia
What K channel blocker is used to increase the refractory period of the cardiac myocytes to prevent re-entry and dysrhythmia?
Amioderone
