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Physiology 1 > Pharmacological Treatment Of Angina > Flashcards

Pharmacological Treatment Of Angina Flashcards

1
Q

Where does the pain come from in angina?

A

Heart muscle- caused by the lactic acid produced during anaerobic respiration
Stimulated myocardial pain receptors which send messages via cardiac nerves and upper posterior nerve routes to the brain

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2
Q

What are the symptoms of angina?

A
  • Feeling of cramping and severe constriction in the chest
  • referred pain- jaw, shoulders, neck and arms
  • may be associated with shortness of breath, sweating and nausea
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3
Q

What are the key facts of chronic stable angina?

A

Affects around 2-4% of the population in western countries
Associated with estimated annual risk of death of 1-2%
Estimate that 1.3 million people in the UK are living with angina

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4
Q

What are the treatment aims of angina?

A

To enhance quality of life through reduction of symptoms
To improve prognosis and prevent complications
Well tolerated and they cause minimal side effects

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5
Q

What are the four types of angina?

A

Stable, unstable, prinzmetal and micro vascular

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6
Q

What are the causes of stable angina?

A

Attributed to myocardial ischaemia

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7
Q

What causes unstable angina?

A

Complications from stable angina

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8
Q

What causes prinzmetal angina?

A

Spasm in coronary arteries

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9
Q

What causes coronary vasospasms?

A

Cocaine use

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10
Q

What is stable angina caused by?

A

Narrow artery lumen -> restricted blood flow to the area of myocardium it supplies-> oxygen it receives is insufficient when the heat has to work harder-> anaerobic respiration -> pain

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11
Q

How is stable angina relieved?

A

Rest or taking medication

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12
Q

What’s the difference between stable and unstable angina?

A

Stable follows a set pattern, unstables predictable

Stable is relieved by rest and medication and unstable isnt

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13
Q

What causes unstable angina?

A

Clot formation occluded artery-> critical reduction in blood flow so oxygen supply is inadequate even at rest

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14
Q

When does prinzmetal angina occur?

A

At rest or through the night

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15
Q

How long does prinzmetal angina last?

A

5-15 mins

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16
Q

How common is prinzmetal angina?

A

Rare (1 in 100)

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17
Q

What are associated symptoms of prinzmetal angina?

A

Heartburn, nausea, sweating, dizziness, palpitations, migraines

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18
Q

What causes microvascular angina?

A

Impaired coronary circulation due to coronary microvascular dysfunction from abnormal vasodilation or increased vasoconstriction

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19
Q

Why can microvascular angina not be diagnosed early?

A

Coronary microvasculature cannot be directly imaged in vivo

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20
Q

What can be used to asses coronary microvascular blood flow?

A

PET scan or cardiac magnetic resonance

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21
Q

What is the definition of angina?

A

An imbalance between demand and supply of oxygen to the heart

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22
Q

What two types of angina cause decreased coronary blood flow?

A

Vasospasm (prinzmetal) and thrombus blockage (unstable)

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23
Q

What type of angina causes an increased oxygen requirement?

A

Fixed stenosis (chronic stable angina)

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24
Q

What are the three precipitating factors of angina?

A

Increased sympathetic activity, contractility and vasoconstriction

25
Q

What are the three strategies of treating angina?

A

Improving perfusion, reducing metabolic demand and prevention

26
Q

What type of drugs improve perfusion?

A

Coronary vasodilation

27
Q

How do coronary vasodilators help with angina?

A

They increase oxygen delivery by improving the coronary blood flow

28
Q

What types of drugs reduce metabolic demand?

A

Vasodilators and cardiac depressants

29
Q

How does reducing the metabolic demand help the treatment of angina?

A

Reduce oxygen demand by decreasing cardiac work

30
Q

What types of drugs help in the prevention of angina?

A

Lipid lowering drugs
Anti-coagulants
Fibrinolytic
Antiplatelet

31
Q

How does the prevention of angina help?

A

Prophylactic to reduce the risk of subsequent episodes

32
Q

Give examples of anti anginal nitrates

A

Glyceryl trinitrates, isosorbide mononitrate effects

33
Q

What two ways do nitrates help in angina?

A

Peripheral venodilation and arterial dilation

34
Q

How does peripheral venodilation help treat angina?

A

Peripheral venodilation-> decreases intraventricular pressure -> decreases cardiac preload

35
Q

How does arterial dilation help treat angina?

A

Decrease TPR-> reduces afterload

36
Q

How do nitrates work against angina?

A

Lower oxygen demands by lowering the work of the heart

37
Q

What are the adverts effects of using nitrates to treat angina?

A
  • throbbing headache, flushing and syncope
  • postural hypotension
  • reflex tachycardia
38
Q

What is the mechanism of action for nitrates in the treatment of angina?

A

Organic nitrates mimic the effects of endogenous nitric oxide

39
Q

What do nitric oxide donors cause?

A

Dilation of smooth muscle

40
Q

How does PKG reduce smooth muscle tone?

A
  • myosin light chain dephosphorylation
  • increased uptake of calcium by SR causing a decrease in cytoplasmic levels
  • activate k+ channels causing hyperpolarisation and closing VGCC
41
Q

What are examples of beta blockers?

A

Atenolol, bidprolol

42
Q

What are the effects of beta blockers?

A
  • Inhibits the If pacemaker current in the SA node -> decreases heart rate
  • reduce the force of cardiac contractions ->improves exercise tolerance
43
Q

How do beta blockers help in the treatment of angina?

A

Reduce cardiac output and blood pressure

44
Q

What are the adverse effects of beta blockers?

A

Bronchospasm
Fatigue
Postural hypotension

45
Q

What is the mechanism of action of beta blockers?

A

Reduces the sympathetic action of noradrenaline on beta 1 adrenoreceptors on the heart

46
Q

What are the three types of calcium channel blockers?

A

Dihydropyridines
Benzothiazepines
Diphenylalkyamines

47
Q

Give examples of dihydropyridines

A

Amplodipine

Nifedipine

48
Q

Give examples of benzothizapines

A

Verpam

49
Q

Give examples of diohenylalkyamines

A

Diltiazem

50
Q

What are the effects of calcium channel blockers?

A
  • reduce calcium ion entry into cardiac myocytes/smooth muscle cells-> reducing contractility
  • direct coronary vasodilation -> more coronary blood flow
  • reduce TPR -> Heart works less hard to eject blood
  • reduce force of contraction -> less o2 consumption
51
Q

What are the adverse effects of calcium channel blockers?

A
  • lower limb oedema
  • flushing and headaches
  • reflex tachycardia
52
Q

Why do you take caution with calcium channel blockers?

A

They block calcium channels in the heart that may alter the electrical conduction and contractility

53
Q

What is the mechanism of action of the calcium channel blockers?

A

Reduce calcium ion influx through voltage gated L-type calcium channels in smooth and cardiac muscles

54
Q

What are the three types of prophylactic angina drugs?

A

Aspirin, clopidogrel and statins

55
Q

How does aspirin work?

A

Inhibits COX, decreases thromboxane A2 and platelet aggregation

56
Q

How does clopidogrel work?

A

Inhibits ADP receptor on platelets, reduces aggregation

57
Q

How do statins work?

A

HMG CoA reductase inhibitor, decreases cholesterol levels

58
Q

What are the other types of anti anginals?

A

Nicorandil, ivabradine, ranzolazine

59
Q

How does nicorandil work?

A

Potassium channel activator leads to hyperpolarisation

Physiology 1 (65 decks)

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