Pharmacology of angina

Question 1

What is the main mechanism of treatment?

Answer 1

Decrease cardiac O2 demand

Question 2

Secondary mechanism of treatment?

Answer 2

Perfusing ischaemic tissue by decreasing heart rate and increasing blood flow in the coronary arteries

Question 3

What is the immediate relief treatment / short term prevention for patients with agina?

Answer 3

Short acting nitrate - GTN

Question 4

Anti-anginal effects of calcium channel blockers?

Answer 4

Vasodilatory effect (reduced after load) and cardiodepressant effect (contractility and rate) - verapamil and dilitiazem

Question 5

Step 1 =

Answer 5

Beta blocker or CCB

Question 6

Step 2 =

Answer 6

Beta blocker + vascular selective CCB

Question 7

Step 3 =

Answer 7

Beta blocker + vascular selective CCB and any 1 of:
Long acting nitrate
Ivabradine
Nicorandil
Ranolazine

Question 8

Long acting nitrate:

Answer 8

Isosorbide mononitrate

Question 9

Ivabradine

Answer 9

Blocks funny current - greater effect as more channels open (haemodynamic effect)

Question 10

Nicorandil

Answer 10

Vasodilatory effect by increasing cGMP levels and opens potassium channels, promoting repolarisation

Question 11

Contraindication for ranolazine?

Answer 11

Liver cirrhosis

Question 12

Ranolazine

Answer 12

Prevents inward sodium current that leads to intracellular calcium influx and decreases wall tension

Question 13

Nitrates

Answer 13

Decrease CVP / preload decreases wall tension and thus cardiac O2 demand and increases coronary blood flow

Question 14

Side effects of nitrates

Answer 14

Reflux increase in heart rate, flush and drop in blood pressure

Question 15

Beta-blocker aims:

Answer 15

Resting HR of 55-60 bpm

Increase of < 75% the rate causing ischaemia during exercise

Question 16

CCBs ordered in order of vasodilatory function:

Answer 16

DTP > dilitiazem > verapamil

Question 17

CCBs ordered in order of negative inotropy:

Answer 17

Verapamil > dilimiazem > DTP

Question 18

CCBs also have a coronary artery dilatory effect useful in which types of angina?

Answer 18

Those with coronary vasoconstriction such as Prinzmetal’s and mixed angina

Question 19

Which drug is contraindicated in pulmonary oedema?

Answer 19

Nicorandil

Question 20

What is nicorandil?

Answer 20

An vasodilatory drug used to treat angina by opening K channels and increasing cGMP

Question 21

Contraindications of nicorandil?

Answer 21

Pulmonary oedema

Left ventricular failure

Question 22

Adverse effects of nicorandil?

Answer 22

Headaches
Flushing
Anal ulceration