PPT 2

Question 1

Glyceryl trinitrate

Answer 1

Nitroglycerin is converted by mitochondrial aldehyde dehydrogenase (mtALDH) to nitric oxide (NO), an active substance which then activates the enzyme guanylate cyclase

Leads to the dephosphorylation of the myosin light chain of smooth muscles, causing relaxation and increased blood flow in veins, arteries and cardiac tissue

Question 2

Isosorbide dinitrate

Answer 2

Vasodilator used in the treatment of angina pectoris. Its actions are similar to nitroglycerin but with a slower onset of actio

Question 3

Nicorandil

Question 4

Ivabridine

Answer 4

Heart rate lowering medicine for the symptomatic management of stable angina pectoralis

Acts by selectively inhibiting the “funny” channel pacemaker current (If) in the sinoatrial node

Question 5

Ranolazine

Answer 5

Adjunctive therapy in the treatment of stable angina in patients inadequately controlled or intolerant of first-line antianginal therapies

Question 6

Aspirin

Answer 6

Acetylsalicylic acid (ASA) blocks prostaglandin synthesis. It is non-selective for COX-1 and COX-2 enzyme

Inhibition of COX-1 results in the inhibition of platelet aggregation for about 7-10 days

Question 7

Dipyridamole

Answer 7

Dipyridamole likely inhibits both adenosine deaminase and phosphodiesterase, preventing the degradation of cAMP, an inhibitor of platelet function. This elevation in cAMP blocks the release of arachidonic acid from membrane phospholipids and reduces thromboxane A2 activity

Question 8

Clopidogrel

Question 9

Ticagrelor

Answer 9

Ticagrelor is a P2Y12 receptor antagonist that prevents ADP-mediated P2Y12 dependent platelet activation and aggregation

Not a prodrug, it may be of use to patients who are poor metabolisers as they may not receive as much benefit from a prodrug

Question 10

Tirofiban

Answer 10

Tirofiban is a reversible antagonist of fibrinogen binding to the GP IIb/IIIa receptor, the major platelet surface receptor involved in platelet aggregation

Question 11

Metolazone

Question 12

Adrenaline

Question 13

Atropine

Answer 13

Binds to and inhibit muscarinic acetylcholine receptors, producing a wide range of anticholinergic effect

Question 14

Flecainide

Answer 14

Flecainide is a Class I anti-arrhythmic agent

Question 15

Lidocaine

Answer 15

Local anaesthetic

Lidocaine agent acts on sodium ion channels located on the internal surface of nerve cell membrane

The postsynaptic neuron will ultimately not depolarize and will thus fail to transmit an action potential

Question 16

Sotalol

Answer 16

Class III anti arrhythmic drug

Inhibits beta-1 adrenoceptors in the myocardium as well as rapid potassium channels to slow repolarization, lengthen the QT interval, and slow and shorten conduction of action potentials through the atria

Question 17

Adenosine

Answer 17

Adenosine slows conduction time through the AV node and can interrupt the reentry pathways through the AV node, resulting in the restoration of normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT), including PSVT associated with Wolff-Parkinson-White Syndrome

Question 18

Digoxin

Answer 18

Na/K ATPase inhibitor

inhibition of the sodium pump by digoxin increases intracellular sodium and increases the calcium level in the myocardial cells, causing an increased contractile force of the heart