Pharmacological Treatment of Angina

Question 1

What shrinks the coronary perfusion window through the LV?

Answer 1

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

Question 2

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

Answer 2

atherosclerosis

Angina

Question 3

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

Answer 3

Thrombosis

Cardiac Infarction

Question 4

What is Angina Pectoris?

Answer 4

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

Question 5

How is angina described?

Answer 5

severe and crushing; tight constricting, dull or heavy

Question 6

What is the characteristic distribution of pain in angina?

Answer 6

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

Question 7

What can angina be brought on by?

Answer 7

Exertion, cold or excitment

Question 8

What is angina thought to be brought on by?

Answer 8

Chemical factors that cause pain in skeletal muscle

Question 9

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

Answer 9

• H⁺
• K⁺
• Adenosine

Question 10

What are the 3 classes of angina?

Answer 10

• Stable
• Unstable
• Variant (Prinzmetal)

Question 11

What is stable angina

Answer 11

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

Question 12

When does unstable angina occur?

Answer 12

Occurs at rest and with less exertion than stable angina

Question 13

What causes unstable angina?

Answer 13

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

Question 14

How common is variant angina?

Answer 14

Uncommon

Question 15

What causes variant angina?

Answer 15

vaused by coronary artery spasm

Question 16

What treatments are used to reduce chest pain symptoms?

Answer 16

• Beta blockers
• Nitrates
• Calcium channel antagonists
• Nicroandil
• Ivabradine
• Ranolazine

Question 17

What treatments are used to prolong survival?

Answer 17

• Beta blockers
• aspirin
• statins
• ACEI
• ARBs

Question 18

What is offered to prevent/treat episodes of angina?

Answer 18

short-acting nitrate

Question 19

What is the first line treatment for angina?

Answer 19

Beta blocker but CCB blocker can be considered

Question 20

How do most anti-anginal drugs work?

Answer 20

by decreasing the metabolic demand of the muscle

Question 21

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

Answer 21

• Organic nitrates
• nicroandil
• calcium antagonists

Decreased preload and afterload

Question 22

Name 2 organic nitrates

Answer 22

Glyceryl trinitrate and isosorbide mononitrate

Question 23

How do organic nitrates work?

Answer 23

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

Question 24

Where do organic nitrates act?

Answer 24

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

Question 25

What helps decrease the cardiac workload?

Answer 25

Helped by dilation of collateral coronary vessels

Question 26

When is collateral blood flow dilated?

Answer 26

when there is a build up of local factors

Question 27

When are organic nitrates used in stable angina?

Answer 27

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

Question 28

When are organic nitrates used in unstable angina?

Answer 28

IV GTN

Question 29

What are the unwanted effects of organic nitrates?

Answer 29

headache and postural hypotension

Question 30

What are the other clinical uses of organic nitrates?

Answer 30

* Acute heart failure * Chronic heart failure - isosorbide mononitrate with hydralazine in patients of African American origin

Question 31

When are beta-blockers used?

Answer 31

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

Question 32

What is the effect of beta-blockers?

Answer 32

Decrease cardiac oxygen consymption by slowing the HR

Question 33

What are the other actions of beta-blockers?

Answer 33

Antidysrhythmic action

Question 34

Examples of beta-blockers

Answer 34

Bisoprolol, atenolol, propranolol

Question 35

What is the action of calcium channel blockers?

Answer 35

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

Question 36

How do CCBs affect the heart?

Answer 36

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

Question 37

Two main types of CCB

Answer 37

* Dihydropyridine derivatives: amlodipine and lercandipine * Rate-limiting: verapamil and diltiazem

Question 38

Where do CCBs act?

Answer 38

Vasodilator effect mainly on resistance vessels * Reduces afterload * Dilate coronary vessels

Question 39

Function of verapamil and diltiazem?

Answer 39

Can reduce and impair AV conduction and myocardial contractility

Question 40

When are amlodipine and lercanidpine used in angina?

Answer 40

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

Question 41

When are diltiazem and verapamil not used?

Answer 41

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

Question 42

Side effects of CCB

Answer 42

* Headache * Constipation * ankle oedema

Question 43

What CCB is used for antidysrhythmia?

Answer 43

Verapamil

Question 44

Action of verapamil

Answer 44

* Slows ventricular rate in rapid atrial fibrillation * Prevents recurrence of supraventricular tachycardia (SVT) * No effect on ventricular arrhytmias

Question 45

What CCBs are used in hypertension?

Answer 45

amlodipine and lercanidipine

Question 46

Action of ivabradine

Answer 46

* Inhibits funny 'funny' channels in the heart * Redcues cardiac pacemakrer activity - slows HR

Question 47

Action of nicorandil (positive channel activators)

Answer 47

* Combines activation of postassium ATP channels with nitrovasodilator actions - causes hyperpolarisation of vascular smooth muscle * Arterial and venous dilator

Question 48

Side effects of nicorandil?

Answer 48

* headaches * flushing * dizziness

Question 49

When is nicroandil used?

Answer 49

Patients who are symptomatic depsite optimal mangament with other drugs