Pharmacology of the CVS Flashcards

1
Q

What is angina?

A

→ Angina is chest pain or pressure

→ due to not enough blood flow to the heart muscle.

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2
Q

What are the symptoms of angina pectoris?

A

→crushing chest pain, also in the jaw, shoulders, arms, etc.
→shortness of breath
→sweating
→ nausea

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3
Q

How many people suffer from angina pectoris in the UK?

A

→2 million sufferers in the UK

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4
Q

What are the symptoms of typical angina?

A

→ typical angina
→ substernal chest discomfort of characteristic quality + duration
→provoked by exertion or emotional stress

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5
Q

How can typical angina be relieved?

A

→ rest + medications

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6
Q

Why is stable angina classified as predictable?

A

→ recurrent episodes have a similar onset pattern, duration + intensity

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7
Q

What does a coronary spasm lead to? (Prinzmetal angina)

A

→ Caused by drugs like cocaine.

→ Critical reduction in blood flow so oxygen supply is inadequate

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8
Q

What is supply ischaemia?

A

→ When there is decreased coronary blood flow due to vasospasm or a thrombus / blockage

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9
Q

What is demand ischaemia?

A

→Increased demand for oxygen in the heart muscle

→ Due to fixed stenosis

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10
Q

What are precipitating factors for angina?

A

→ Increased sympathetic activity
→ Increased contractility - exercise, emotion or stress
→ Increased vasoconstriction

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11
Q

What are the three ways to treat angina?

A

→ Improving perfusion
→ Reducing metabolic demand
→ Prevention

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12
Q

How do you improve perfusion with angina?

A

→ Increase oxygen delivery by improving coronary blood flow

→ coronary vasodilators

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13
Q

How do you reduce metabolic demand with angina?

A

→ Decrease cardiac work
→ Using vasodilators ( reduce afterload + preload)
→ Using cardiac depressants ( reduce HR + contractility)

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14
Q

How do you prevent angina?

A

→ Prophylactic to reduce risk of episodes
→ lipid lowering
→ anti-coagulants
→ Fibrinolytic

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15
Q

What does clot formation lead to? (unstable angina)

A

→ Occludes the artery

→ There is a critical reduction in blood flow so oxygen supply is inadequate even at rest

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16
Q

What does a narrowed coronary artery lumen lead to? (stable angina)

A

→ Restricted blood flow to area of the myocardium it supplies
→ Oxygen is receives is insufficient when the heart has to work harder
→ Anaerobic respiration
→Pain

17
Q

How is preload reduced by giving nitrates?

A

→ Peripheral venodilation
→ Decreases intraventricular pressure
→ Cardiac preload decreases

18
Q

How is afterload reduced by giving nitrates?

A

→ Arterial dilation
→ Decreases total TPR
→ Reduces afterload

19
Q

What are adverse effects of nitrates and why?

A

→ Headache, flushing, syncope ( arterial dilation)
→ Postural hypotension ( venodilation)
→ Reflex tachycardia ( sympathetic outflow)

20
Q

How does nitric oxide work?

A

→ NO activates guanylyl cyclase
→ It activates cGMP
→ Activates protein kinase G

21
Q

How does PKG reduce smooth muscle tone?

A

→ Increase uptake of Ca2+
→ Myosin light chain dephosphorylation
→ Activates K+ channels causing hyperpolarization + closing VGCC

22
Q

What do organic nitrates mimic?

A

→ Mimic the effects of endogenous nitric oxide

23
Q

How do beta blockers reduce CO and lower blood pressure?

A

→ Inhibit funny current in the SA node

→ Reduce the force of cardiac contractions

24
Q

How do beta blockers slow heart rate?

A

→ Lengthens diastole and gives more time for coronary perfusion
→ Improves myocardial oxygen supply

25
What are the contraindications of beta blockers?
ASTHMA → Blocking beta two can cause constriction + bronchospasm HEART BLOCK → AV conduction is poor can block AV node
26
How do calcium blockers reduce contractility?
→ Reduce Ca2+ entry into the myocytes
27
How do calcium blockers cause more coronary blood flow?
→ Direct coronary vasodilatation
28
What is the effect of reducing TPR/ BP/ Afterload due to calcium channel blockers?
→ Heart works less hard to eject blood
29
How do Ca2+ blockers cause less O2 consumption?
→ Reducing the force of contraction
30
What are adverse effects of Ca2+ blockers?
→ Lower limb oedema → Flushing + headache → Reflex tachycardia
31
What is a risk of using Ca2+ blockers?
→ Blocking Ca2+ channels in the heart can change electrical conduction + contractility
32
What is the mechanism of action of Ca2+ blockers?
→ Reduce Ca2+ influx through voltage gated L-type channels in smooth + cardiac muscle
33
What are three drugs given when Ca2+ blockers don't work?
→ Nicorandil, ivabradine and ranolazine
34
What are three prophylactic drugs for angina?
→ aspirin - reduces platelet aggregation → clopidogrel - reduces platelet aggregation → Statins - reduces cholesterol