pharmacological treatment of angina Flashcards
what are the three different classes of angina?
variant (prinzmetal) angina
stable (chronic) angina
unstable angina
what causes variant (prinzmetal) angina?
coronary artery spasm
may be related to sympathetic nerve supply to the coronary arteries
what causes stable (chronic) angina?
fixed narrowing of coronary arteries
what causes unstable angina?
formation of a thrombus around ruptured atherosclerotic plaque
which class of angina occurs on exertion?
stable angina
coronary blood flow is met at rest but cannot meet oxygen demands with exertion
which two classes of angina are defined as SUPPLY ISCHAEMIA?
variant angina and unstable angina
what type of ischaemia is stable angina defined as?
demand ischaemia (exertion increases the oxygen demand on cardiac muscle)
what are three different changes which result in a shorter window to supply the heart with blood via the coronary arteries?
- shortening diastole
- increased ventricular end diastolic pressure
- decreasing arterial diastolic pressure (e.g. mitral or aortic valve incompetence or heart failure)
what is the definition of angina pectoris?
chest pain due to inadequate supply of oxygen to the heart
where is the characteristic distribution of angina chest pain?
chest, arm, jaw and neck
what is the main mechanism of action of abtianginal drugs?
mainly work by decreasing the metallic demands of the heart muscle
how do vasodilators decrease the metabolic demands of the heart?
decrease preload therefore decrease the work the heart has to do to refill the ventricles
decrease after load (pressure in the aorta) - decreasing the work the heart has to work to push against - decrease total peripheral resistance
what are the three main vasodilators of the heart?
organic nitrates, nicorandil (potassium channel activator) and calcium antagonists
what two drugs slow down the heart rate?
beta blockers and ivabradine
what are the two beta blockers commonly used in the treatment of angina?
bisoprolol and atenolol
what type of channel do calcium channel inhibitors prevent from opening?
L-type calcium channels
what are the two dihydropyridine derivative calcium antagonists?
Amlodipine
Lercanidipine
what are the two rate-limiting calcium antagonists?
Verapamil
Diltiazem
which calcium antagonists WOULD NOT be used in conjunction with beta blockers, with patients with heart failure or an AV block?
Diltiazem
Verapamil
which calcium antagonists can also be used to treat hypertension?
amlodipine
lercanidipine
which calcium antagonist can be used to treat ventricular dysrhythmias?
(used to decrease ventricular rate in AF, prevents recurrence of supra ventricular tachycardia
(BUT no effect on ventricular arrythmias)
Verapamil
which organic Nitrate is given sublingually to stable angina pateinets SHORTLY before exertion?
Glyceryl trinitrate
which organic nitrate can be given sublingually to stable angina patients A LONG TIME BEFORE exertion?
Isosorbide mononitrate
which organic nitrate can be given to patients intravenously in UNSTABLE ANGINA?
glyceryl trinitrate
which organic nitrate can be given to ACUTE HEART FAILURE patients INTRAVENOUSLY?
glyceryl trinitrate
which organic nitrate can be given to chronic heart failure patients in conjunction with HYDRAZINE?
isosorbide mononitrate
what are two common side effects of organic nitrates?
headaches, postural hypotension
what are three common side effects of calcium inhibitors?
headaches, constipation and ankle oedema
what is the name of a POTASSIUM CHANNEL ACTIVATOR?
NICORANDIL
what are three common side effects of nicroandil?
flushing, dizziness and headaches
what type of channels does IVABRADINE inhibit, reducing cardiac pacemaker ability?
f-type sodium channels
what is the name of the drug used as a last-resort in the treatment of angina?
Ranolazine
