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Pharmocolgy > P14: Ischaemic Heart Disease Angina > Flashcards

P14: Ischaemic Heart Disease Angina Flashcards

1
Q

Does coronary perfusion happen in systole or diastole

A

only diastole

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2
Q

What local metabolic methods control coronary artery diameter

A

Local, transient ischaemia causes the release of vasoactive metabolites

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3
Q

What autonomic methods control coronary artery diameter

A

Larger coronary vessels = alpha1-adrenceptors, constriction

Smaller arteries = beta2-adrenceptors, relaxation

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4
Q

What is coronary stenosis

A

The narrowing of the arteries, leading to insufficient oxygen supply to the cardiac muscle

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5
Q

How is coronary stenosis often diagnosed

A

Sound of turbulent blood flow through the narrowed part of the artery

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6
Q

What is angina pectoris

A

A sensation of chest squeezing and pain, particularly following excercise, linked to stenosis

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7
Q

Is there a link between pain severity and myocardial oxygen deprivation

A

No, low pain can mean high deprivation and low deprivation

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8
Q

What is stable angina (effort angina)

A

Classic form of condition
Pain is minimal at rest and develops upon exercise or stress
Symptoms classically fade rapidly on rest

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9
Q

What is unstable angina (crescendo angina)

A

Angina that escalates
Commonly occur at rest or on minimal action
Severe and acute onset
Crescendo pattern - each episode is more severe than the last

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10
Q

What is the difference in the pathological process between stable and unstable angina

A

Chronic atherosclerosis - stable

Acute vascular blockade - unstable

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11
Q

What are the 3 stages of plaque development in athersclerosis

A
  1. Abnormal accumulation of lipid
  2. Fibrous tissue in the vessel wall narrows or occludes the vessel lumen
  3. Reduced blood flow
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12
Q

What is prinzmetal angina

A

coronary artery muscular spasm

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13
Q

Rupture of vessel plaque can lead to what

A

rapid thrombus development

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14
Q

What can untreated stable angina lead to

A

Unstable angina and then a heart attack

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15
Q

Name some risk factors for angina

A 
Hypertension
Hyperlipidaemia
Smoking
Diabetes Mellitus
Obesity
Being Male
Stress
Menopause
Systemic infections
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16
Q

What is the goal of angina treatment

A

Reduce the workload of the heart and its oxygen consumption

17
Q

What is the equation for heart workload

A

Stroke volume x arterial pressure x heart rate

18
Q

What can affect heart workload besides the equation tings

A

Preload - venous return
Afterload - peripheral resistance
Sympathetic stimulation

19
Q

What are the 3 main classes of pharmacological treatment for angina

A
  • Organic Nitrate Donors
  • Beta-Adrenoceptor antagonists
  • Calcium channel blockers
20
Q

Name some organic nitrate donor drugs for angina

A 
Glyceryl trinitrate (short acting)
Isosorbide Dinitrate (long acting)
21
Q

Name some Beta-Adrenoceptor antagonists for angina

A

Propranolol

Atenolol

22
Q

Name some calcium channel blocker drugs for angina

A

Nifedipine

Nicardipine

23
Q

What are angina drugs supplemented with

A

Anti-platelets/Anti-thrombotics - aspirin

Antilipidaemic agents - statins

24
Q

Describe the mechanism of organic nitrates

A

Widespread peripheral vasodilation
- Reduces preload by action on venules
- Reduces after load by peripheral arteriolar relaxation
Some action on coronary artery dilation

25
Q

Give examples of organic nitrates

A

Glyceryl trinitrate

Isosorbide mono/dinitrate

26
Q

What are the half lifes of glyceryl trinitrate and isosorbide mono/dinitrate

A 
GT = 2 minutes
IS/D = 1 hour
27
Q

How are organic nitrates administered - give pros of each

A

Sublingual - fast acting, acute attack
Oral/Transdermal “nitropatch” slow release: maintenance therapy
IV - to control unstable angina

28
Q

What are the adverse affects of organic nitrates

A
  • Vasodilation and hypotension
  • Met-haemoglobinaemia (increased O2 carrying capacity)
  • Tolerance due to depletion of tissue thiols
29
Q

Name some Beta-adrenoceptor antagonists and how they aim to work

A

Propanolol
Atenolol
Reduce O2 demand by decreasing cardiac workload

30
Q

What receptors do Propanolol and Atenolol work at

A

Propanolol - Non-selective Beta1 and beta2 antagonists

Atenolol - Cardioselective Beta1 antagonist

31
Q

What are the side effects of beta-adrenoceptor antagonists

A 
Hypotension
Bradycardia
Bronchoconstriction
Hyperlipidaemia
Depression
Fatigue
reduced libido
32
Q

What is the aim of calcium channel blocker drugs

A

Block entry of Ca2+ into muscle cells, reducing myocardial contractility, electrical impulse propagation and vascular tone

33
Q

Name some cardiac favouring calcium channel blockers

A

Diltiazam

Verapamil

34
Q

Describe the mechanism of cardiac favouring calcium channel blockers

A

Decreased SA node auromaticity and AV node conduction, resulting in decreased HR and decreased myocardial contractility

35
Q

Name some vessel favouring calcium channel blockers

A

Nicardipine

Nifedipine

36
Q

Describe the mechanism of vessel favouring calcium channel blockers

A

Relax blood vessels (arterial vasodilation) therefore decreased BP (workload) and increased coronary artery perfusion (increased oxygen supply)

37
Q

What are the potential side effects of calcium channel blockers

A 
Hypotension
AV block
Bradycardia
Constipation
Gastric Distress
38
Q

What is the main surgical procedure after a myocardial infarction

A

Angioplasty

39
Q

What is an angioplasty

A

When you use a stent and open it to open the block with a mesh ting

Pharmocolgy (22 decks)

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