Pharmacological treatment of angina

Question 1

What shrinks the window for coronary perfusion?

Answer 1

• Shortening diastole
• Increased ventricular end diastolic pressure
• Reduced diastolic arterial pressure

Question 2

What causes angina

Answer 2

Coronary ischaemia as a result of atherosclerosis

Question 3

What is sudden ischaemia usually caused by?

Answer 3

Thrombosis

Question 4

What is variant angina caused by?

Answer 4

Coronary spasms

Question 5

What can calcium overload cause?

Answer 5

• May cause cell death and ischaemias

Question 6

What is the definition of angina?

Answer 6

Chest pain due to inadequate supply of oxygen to the heart

Question 7

Whhat is the characteristic distribution of angina pain?

Answer 7

• Often retrosternal, or left side of chest and can radiate to the left arm, neck, jaw and back

Question 8

What is angina pectoris (stable angina) brought about by?

Answer 8

Exertion, cold, excitement

Question 9

What can angina be a precursor for?

Answer 9

Heart attack

Question 10

What is variant (Printzmetal’s) angina?

Answer 10

Caused by coronary artery spasm (supply ischemia)

Question 11

What types of angina are supply angina?

Answer 11

Printzmetal’s variant angina and unstable angina

Question 12

What is unstable angina brought about by?

Answer 12

• Associated with a thrombus around a ruptured atheromatous plaque but without complete occlusion of the vessel (similar to MI)

Question 13

What type of angina is associated with platelet aggregation?

Answer 13

Unstable

Question 14

What drugs can be used to reduce chest pain symptoms (angina)?

Answer 14

• Beta-blockers
• Nitrates
• Calcium channel antagonists
• Nicorandil
• Ivabradine
• Ranolazine

Question 15

What drugs can be used to prolong survival (angina)?

Answer 15

• Beta-blockers
• Aspirin
• Statins
• ACE inhibitors
• Angiotensin II Receptor blockers

Question 16

What classes ofdrugs are used to treat symptoms of angina?

Answer 16

• Short-acting nitrate
• Beta-blockers
• Addition of CCBs can be considered

Question 17

If beta blockers or CCB monotherapy is ineffective and the other option is contraindicated what other drugs may be addtionally used?

Answer 17

Nicorandil or ivabradine

Question 18

What drugs used to treat angina are classed as vasodilators?

Answer 18

• Organic nitrates
• Nicorandil
• Calcium antagonists

Question 19

What classes of drugs slow down the heart?

Answer 19

Beta blockers and ivabradine

Question 20

Name drugs that are classed as organic nitrates?

Answer 20

Glyceryl trinitrate and isosorbide mononitrte

Question 21

How do nitrates specifically work?

Answer 21

They are metabolised to NO and relax smooth muscle

Question 22

How does the administration of GTN differ between unstable and stable angina?

Answer 22

• Stable = sublingually

- Unstable = IV

Question 23

What are the unwanted side-effects of organic nitrates?

Answer 23

• Headaches

- Postural hypotension

Question 24

What other conditions can be treated with organic nitrates?

Answer 24

• Acute HF (IV GTN)

- Chronic HF (isosorbide mononitrate with hydralazine)

Question 25

When is isosorbide mononitrate with hydralazine administred for Chronic HF?

Answer 25

• Often in patients with african origin

- Or patient cannot tolerate more commonly used CHF drugs

Question 26

What are the common Beta blockers administred for angina?

Answer 26

Bisoprolol, atenolol

Question 27

How do calcium channel blockers work?

Answer 27

They prevent the opening of voltage-gated L-type Ca2+ channels.
Mainly affect the heart and smooth muscle to inhibit calcium entry upon muscle cell depolarisation

Question 28

What are the two main types of CCBs?

Answer 28

• Dihydropyridine derivatives

- Rate-limiting

Question 29

What drugs are considred Rate-limiting CCBs?

Answer 29

Verapamil and diltiazem

Question 30

What drugs are considred - Dihydropyridine derivative CCBs?

Answer 30

Amlodipine and lercanidipine

Question 31

What type of CCBs can can reduce and impair AV conduction and myocardial contractility?

Answer 31

Rate-limiting CCBs

Question 32

What can the side-effects of CCBs be?

Answer 32

• Headache
• Constipation
• Ankle oedema

Question 33

What CCB is mainly used in antidysrhythmics?

Answer 33

Verapamil

Question 34

What CCBs can be used to treat hypertension?

Answer 34

• Mainly amlodipine or lercanidpine

Question 35

What anti-anginal drug inhibits Funny channels?

Answer 35

Ivabradine

Question 36

What unique anti-anginal is used as a last resort to treat angina?

Answer 36

Ranolazine

Question 37

What anti-anginal drug is classed as a potassium channel activator

Answer 37

Nicorandil (used in patients who remain symptomatic despite management with other drugs)

Question 38

What are the side-effects of nicorandil?

Answer 38

• Headaches
• Flushing
• Dizziness

Question 39

How do potassium channel activators work (nicorandil)?

Answer 39

• Combines activation of potassium K+ATP channels with nitrovasodilator actions
• Causes hyperpolariation of vascular smooth muscle

Question 40

What class of CCBs are safe in patients with HF?

Answer 40

DHP derivatives (amlodipine and lercanidipine)

Question 41

In what type of angina are DHP derived CCBs used instead of Beta-blockers?

Answer 41

Printzmetal angina

Question 42

In what conditions can rate-limiting CCBs (diltiazem and verapamil) not be used?

Answer 42

• HF
• Bradycardia
• AV block
• In presence of beta-blocker

Question 43

What drug prevents the recurrence of supraventricular tachycardia (SVT)?

Answer 43

Verapamil