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MD3001 - Cardiology Pharmacology > Pharmacological Treatment of Angina > Flashcards

Pharmacological Treatment of Angina Flashcards

1
Q

What shrinks the coronary perfusion window through the LV?

A
  • Shortening diastole (increased HR)
  • Increased ventricular EDP (aortic stenosis)
  • Reduced diastolic arterial pressure (valve incompetence/heart failure)
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2
Q

What is coronary ischaemia usually a result of? And what does it cause?

A

atherosclerosis

Angina

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3
Q

What is sudden ischaemia usually caused by? And what may it result in?

A

Thrombosis

Cardiac Infarction

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4
Q

What is Angina Pectoris?

A

Symtpom of chest pain due to an inadquete supply of oxygen to the heart

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5
Q

How is angina described?

A

severe and crushing; tight constricting, dull or heavy

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6
Q

What is the characteristic distribution of pain in angina?

A
  • Retrosternal, or left sude of chest and can radiate to the left arm, neck, jaw and back
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7
Q

What can angina be brought on by?

A

Exertion, cold or excitment

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8
Q

What is angina thought to be brought on by?

A

Chemical factors that cause pain in skeletal muscle

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9
Q

What are the chemical factors that cause pain in skeletal muscle?

A
  • H+
  • K+
  • Adenosine
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10
Q

What are the 3 classes of angina?

A
  • Stable
  • Unstable
  • Variant (Prinzmetal)
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11
Q

What is stable angina

A
  • Predictable chest pain on exertion
  • Caused by a fixed narrowing of the coronary arteries
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12
Q

When does unstable angina occur?

A

Occurs at rest and with less exertion than stable angina

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13
Q

What causes unstable angina?

A

Assocaited with thormbus around a ruptured atheromatous plaque but without complete occlusion

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14
Q

How common is variant angina?

A

Uncommon

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15
Q

What causes variant angina?

A

vaused by coronary artery spasm

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16
Q

What treatments are used to reduce chest pain symptoms?

A
  • Beta blockers
  • Nitrates
  • Calcium channel antagonists
  • Nicroandil
  • Ivabradine
  • Ranolazine
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17
Q

What treatments are used to prolong survival?

A
  • Beta blockers
  • aspirin
  • statins
  • ACEI
  • ARBs
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18
Q

What is offered to prevent/treat episodes of angina?

A

short-acting nitrate

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19
Q

What is the first line treatment for angina?

A

Beta blocker but CCB blocker can be considered

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20
Q

How do most anti-anginal drugs work?

A

by decreasing the metabolic demand of the muscle

21
Q

What drugs are vasodilators and how do the affect the heart?

A
  • Organic nitrates
  • nicroandil
  • calcium antagonists

Decreased preload and afterload

22
Q

Name 2 organic nitrates

A

Glyceryl trinitrate and isosorbide mononitrate

23
Q

How do organic nitrates work?

A

Powerful vasodilatord that work by being metabolised to NO and relex smoohth muscle

24
Q

Where do organic nitrates act?

A

Act on veins to decrease preload. At higher concentrations can act on arteries too and decrease afterload

25
Q

What helps decrease the cardiac workload?

A

Helped by dilation of collateral coronary vessels

26
Q

When is collateral blood flow dilated?

A

when there is a build up of local factors

27
Q

When are organic nitrates used in stable angina?

A

prevention by sublingual GTN spray shortly before exertion or isosorbide mononitrate long before

28
Q

When are organic nitrates used in unstable angina?

A

IV GTN

29
Q

What are the unwanted effects of organic nitrates?

A

headache and postural hypotension

30
Q

What are the other clinical uses of organic nitrates?

A
  • Acute heart failure
  • Chronic heart failure - isosorbide mononitrate with hydralazine in patients of African American origin
31
Q

When are beta-blockers used?

A

First line treatment in prophylaxis and treatment of stable and unstable angina

32
Q

What is the effect of beta-blockers?

A

Decrease cardiac oxygen consymption by slowing the HR

33
Q

What are the other actions of beta-blockers?

A

Antidysrhythmic action

34
Q

Examples of beta-blockers

A

Bisoprolol, atenolol, propranolol

35
Q

What is the action of calcium channel blockers?

A

Preventing opening of voltage gated L-type Ca2+channels - Block Ca2+ entry

36
Q

How do CCBs affect the heart?

A

affect the heart and smooth muscle to inhibit calcium entry upon muscle depolarisation

37
Q

Two main types of CCB

A
  • Dihydropyridine derivatives: amlodipine and lercandipine
  • Rate-limiting: verapamil and diltiazem
38
Q

Where do CCBs act?

A

Vasodilator effect mainly on resistance vessels

  • Reduces afterload
  • Dilate coronary vessels
39
Q

Function of verapamil and diltiazem?

A

Can reduce and impair AV conduction and myocardial contractility

40
Q

When are amlodipine and lercanidpine used in angina?

A

safe in pateints with heart failure, used instead of a beta-blocker in variant angina or alongside a beta blocker in most angina

41
Q

When are diltiazem and verapamil not used?

A

contraindicated in heart failure, bradycardia, AV block or in the presence of a beta blocker

42
Q

Side effects of CCB

A
  • Headache
  • Constipation
  • ankle oedema
43
Q

What CCB is used for antidysrhythmia?

A

Verapamil

44
Q

Action of verapamil

A
  • Slows ventricular rate in rapid atrial fibrillation
  • Prevents recurrence of supraventricular tachycardia (SVT)
  • No effect on ventricular arrhytmias
45
Q

What CCBs are used in hypertension?

A

amlodipine and lercanidipine

46
Q

Action of ivabradine

A
  • Inhibits funny ‘funny’ channels in the heart
  • Redcues cardiac pacemakrer activity - slows HR
47
Q

Action of nicorandil (positive channel activators)

A
  • Combines activation of postassium ATP channels with nitrovasodilator actions - causes hyperpolarisation of vascular smooth muscle
  • Arterial and venous dilator
48
Q

Side effects of nicorandil?

A
  • headaches
  • flushing
  • dizziness
49
Q

When is nicroandil used?

A

Patients who are symptomatic depsite optimal mangament with other drugs

MD3001 - Cardiology Pharmacology (8 decks)

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