PHARM: Angina

Question 1

Sx of angina and how can it be different in females?

Answer 1

• severe, crushing pain
• SOB lasting a few mins
• females often present w/ N&V, back/jaw pain, radiating to shoulder

Question 2

3 types of angina (in terms of relative plaque/thrombi load)

Answer 2

• stable: only on exertion, high plaque load only and no thrombi
• unstable: @ rest, some plaque and some thrombi formation
• variant (vasospastic) angina: no atherosclerosis, spasm of coronary artery

Question 3

3 main drug classes to treat angina

Answer 3

• nitrovasodilators (1st line)
• beta blockers (2nd line)
• DHP calcium channel blockers (3rd line, if B-blockers contraindicated)

Question 4

4 MECHANISMS to treat angina

Answer 4

• reduce contractility and heart rate = decreased oxygen demand AND increase coronary artery perfusion time = more sustained oxygen supply to the heart
• decrease TPR to decrease afterload
• reduce venous pressure to reduce preload/EDC
• dilate coronary arteries to increase perfusion to cardiac tissue

Question 5

inotropy, chronotropy, dromotropy

Answer 5

• inotropy = effect on contractility of heart
• chroNotropy = effect on SA node conduction and therefore HR
• dromotropy = effect on AV node conduction

Question 6

nitrovasodilators MOA, indications and example

Answer 6

• cause NO release in SMOOTH MUSCLE = increased cGMP = decreased Ca2+ = vasodilation
• reduces venous return, ultimately to decrease cardiac O2 demand
• independent of endothelium so can function if its damaged
• indications: angina (stable or unstable)
• e.g. nitroglycerin (GTN), isosorbide dinitrate

Question 7

contraindications and adverse effects of nitrovasodilators

Answer 7

• contraindicated w/ viagra (severe hypotension)
• AEs: hypotension, reflex tachycardia (therefore increased O2 consumption), headache (due to increased intracranial pressure), flushing, can develop tolerance after continual exposure

Question 8

how is GTN administered?

Answer 8

• sublingually

Question 9

what makes nitrovasodilators better than other vasodilators

Answer 9

• others only vasodilate the normal, functioning circuits = more blood flow to places that don’t need it
• nitros also vasodilate collateral circuits to perfuse evenly

Question 10

MOA and indications of B blockers

Answer 10

• blocks B1 receptors = decreased rate (-ve chronotrope) and force of contraction (-ve inotrope) = prevent arrhythmias
• leads to decreased BP (for HTN)
• decreased O2 consumption and increased coronary artery perfusion time (for HFrEF + angina)
• indications: HTN, HFrEF, angina, tachyarrhythmias

Question 11

adverse effects and contraindication of B blockers

Answer 11

• A/Es: cold extremities, bradycardia, bronchoconstriction
• contraindicated in asthma, UNSTABLE heart failure and with class IV anti-arrhythmics (non-DHP Ca2+ channel blockers)

Question 12

DHP Ca2+ channel blockers MOA + indications

Answer 12

• MOA: inhibit L-type Ca2+ channels in blood vessels = vasodilation = decreased afterload = decreased BP (for HTN) and decreased O2 consumption (for angina)
• indications: HTN, angina (stable + vasospastic)

Question 13

adverse effects and contraindications of DHP Ca2+ channel blockers

Answer 13

• AEs: cardiac depression, bradycardia, flushing, oedema, dizziness, headache, constipation, nausea
• C/I: heart failure and aortic stenosis