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Cardiovascular > Pharmacology of Stable Coronary Disease > Flashcards

Pharmacology of Stable Coronary Disease Flashcards

1
Q

Describe stable angina?

A

Predictable chest pain precipitated by exercise or emotional stress which increases with myocardial oxygen demand

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2
Q

What are the non-modifiable risk factors?

A

Family history, post-menopausal female, other arterial disease and male

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3
Q

Describe modifiable risk factors?

A

Hypertension
Smoking
Diabetes
Hyperlipidaemia

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4
Q

How does angina arise?

A

Mismatch between myocardial oxygen supply and the myocardial demand
Increase myocardial blood flow and reduce the demand

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5
Q

What increases myocardial demand?

A

HR, preload, afterload, myocardial contractibility, relaxation and wall stress

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6
Q

How do we treat?

A

Relieve symptoms
Slow/ halt the disease process
Prevent myocardial infarction
Prevent premature death

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7
Q

What are rate limiting drugs used for relieving symptoms?

A

Beta-adrenoreceptor antagonist
Calcium channel blocker (L-type)
Ivabradine (f-channels)

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8
Q

What are some vasodilators which are used to relieve symptoms?

A

Nitrates
Calcium channels blockers
Potassium channel activator

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9
Q

What is the sodium channel activator used to relive symptoms?

A

Ranolazine

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10
Q

What are some antiplatelets used for disease modification?

A

Aspirin
Clopidogrel
Ticagrelor
Prasugrel

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11
Q

What are some cholesterol lowering drugs used for disease modication?

A

HMG-CoA reductase inhibitors
Fibrates
PCSK-9 inhibitors

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12
Q

What is the mechanism of action for beta-blockers?

A

reversible inhibitor of beta 1 and beta 2 receptors
Blocks the sympathetic system
Can be selective or non-selective

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13
Q

What are the side effects/ cautions for beta-adrenoreceptor antagonists?

A

Asthma, peripheral vascular disease, acute heart failure and bradycardia or heart block

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14
Q

What are cardio selective and non selective beta blockers?

A

Cardio selective - bisoprolol, metoprolol, atenolol
Non-selective - Carvedilol, propranolol

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15
Q

What are the benefits of beta blockers?

A

HR reduced so reduced workload
Decreased contractibility
Improves relaxation
Increases diastolic perfusion time
Reduces rate of ischaemic events and mortality

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16
Q

What is the mechanism of action for calcium channel blockers?

A

Prevent calcium influx into myocytes and smooth muscle arteries by blocking L type Ca channels
Dihydropyridine used to relax smooth muscle
Non-dihydropyridine mostly reduce HR
Act on Alpha 1 subunit

17
Q

What are the benefits for calcium channel blockers?

A

HR reduced
Reduce contractibility, afterload (DHP) and perfusion time is increased

18
Q

What are some side effects of calcium channel blockers?

A

Bradycardia/heart block and reduced LV function
Also reduced hypotension

19
Q

What is the mechanism of action of nitrates?

A

NO mediated smooth muscle relaxation, non-selective, long acting preparations are most effective and sublingual for acute - spray

20
Q

What are side effects of nitrates?

A

Severe aortic stenosis
Hypotension
Headache

21
Q

What are the benefits of nitrates?

A

reduced preload and afterload so myocardial workload is reduced
Improved coronary flow as vasodilation

22
Q

What is the mechanism of action for Nicorandil - potassium channel activator?

A

Activates ATP sensitive potassium channels causing potassium influx
Resultant inhibition of Ca influx - negative inotrope and smooth muscle relaxation

23
Q

What are the side effects of Potassium channel activators?

A

Hypotension and GI ulceration

24
Q

What is the mechanism of action for Ivabradine - funny channel inhibitor?

A

Inhibits the funny channels located in SA node and only work when patient is in sinus rhythm

25
Q

What are the side effects of Ivabradine?

A

Bradycardia and SA node disease

26
Q

What are the benefits of Ivabradine?

A

HR is reduced when sinus rhythm
Reduces rates of infarction

27
Q

What is first step in treatment?

A

BB or CCB

28
Q

What is the mechanism of action for sodium channel drugs - Ranolazine?

A

Inhibits late sodium current in myocardial cells and inhibits rapid phase of potassium rectifier current
Na+/K+ balance across membrane
Reduces intracellular calcium

29
Q

What the benefits of sodium channel late inward current?

A

Reduced O2 demand due to reduced wall stress - easier to perfuse microcirculation
Possible antiarrhythmic effects

30
Q

What are statins used?

A

Atorvastatin
Simvastatin
Rosuvastatin

31
Q

What is involved in slow disease progression?

A

Statins, Reduced cholesterol absorption, fibrates

32
Q

What are the benefits of lipid lowering therpaies?

A

Reduced rate of MI and plaque stabilisation

33
Q

Describe thromboxane A2 inhibitor

A

Antiplatelet
Inhibits platelets activation
Aspirin

34
Q

Describe P2Y12 inhibitors

A

Inhibits platelet activation via ADP mediated pathway

35
Q

What is the benefit of aspirin?

A

Reduces adverse cardiac events like MI or death when used properly

36
Q

Why is aspirin not recommended for prophylaxis?

A

Associated with bleeding GI risk
Proton pump inhibitor used as protection to reduce acid

Cardiovascular (33 decks)

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