Pharmacology of angina

Question 1

What is the structure of an atherosclerotic plaque

Answer 1

A fibrous cap surrounding an atheroma (a soft pool of extracellular lipid + cell debris)

Question 2

What are the types of angina

Answer 2

Stable: most common, occurs on effort; increased o2 demand and restricted blood flow
Mixed angina: unpredictable, different levels of exercise
Vasospastic (Prinzmetal’s): rarer, spasm of coronary artery - occurs at rest
Microvascular: constriction of microvasculature
Unstable: formation of non-occlusive thrombus

Question 3

Describe stable angina

Answer 3

Symptoms:
Tightness, squeezing, crushing sensation on chest

Due to exercise, emotion

Stops with rest/GTN

Question 4

What are the features and classifications of angina pectoris as in OHCM

Answer 4

Features:

• Constricting of chest, jaw, neck, shoulders or arms.
• Symptoms brought on by exertion
• Symptoms relieved by rest/GTN

3 features = typical angina
2 = atypical angina
1 = non-anginal chest pain

Question 5

What investigations are to be used for angina pectoris (OHCM)

Answer 5

ECG - usually normal
Exercise ECG
Angiography

Question 6

How is angina pectoris managed (OHCM)

Answer 6

To prevent CVD:
Address exacerbating factors (anaemia, tachycardia, thyrotoxicosis)
Lifestyle changes
75mg aspirin daily

3 step treatment:
1) beta blocker + calcium channel blocker

2) beta blocker + vascular selective CCB

3) beta blocker + VSCCB +
one of: long lasting nitrate, ivabradine, ranolazine, nicorandil (n’irn)

Question 7

Why is ivabradine used to treat angina pectoris, at what dosage?
(OHCM)

Answer 7

Reduces HR and therefore O2 demand + slower heart rate increases the diastolic period therefore increasing blood flow to the heart

5mg bd or 2.5mg in elderly

Question 8

Why is ranolazine used to treat angina pectoris, at what dosage?
(OHCM)

Answer 8

Decreases wall tension, reducing O2 demand as efficiency increases.
375mg bd dont use if <60kg, elderly, HF

Question 9

Why is nicorandil used to treat angina pectoris, at what dosage?
(OHCM)

Answer 9

Decreases wall tension, reducing O2 demand as efficiency increases. 5-10mg bd

Question 10

Why are long acting nitrates used to treat angina pectoris, give an example of one
(OHCM)

Answer 10

Decreases wall tension, reducing O2 demand as efficiency increases.
Isosorbide mononitrate dose depends on forumulation

Question 11

Give an example of a calcium channel blocker used to treat angina pectoris and its dosage
(OHCM)

Answer 11

Amlodipine 5mg od

Question 12

Give 2 examples of a beta blockers used to treat angina pectoris and its dosage (OHCM)

Answer 12

atenolol 5mg od

bisoprolol 5-10mg od

Question 13

How long does it take for a tolerance to develop when using nitrates to treat angina pectoris? How can it be prevented?

Answer 13

Tolerance develops after 12 hours, can be avoided by a daily 8 hour drug free period (usually at night)

Question 14

What is the goal resting HR for a patient on beta blockers

Answer 14

55-60 BPM