sihd and angina therapy

Question 1

whats the most common cause of death in pre-retirement males?

Answer 1

ischaemic heart disease

Question 2

what are acute coronary syndromes?

Answer 2

myocardial infarction- STEMI or NSTEMI

unstable angina pectoris

Question 3

what are stable coronary artery disease?

Answer 3

angina pectoris

silent ischaemia

Question 4

what are risk factors for stable coronary artery disease?

Answer 4

hypertension
smoking
hyperlipidaemia
hyperglycaemia
male
post-menopausal females

Question 5

why do stable coronary artery diseases arise?

Answer 5

as a result of a mismatch between myocardial blood/ oxygen supply and demand

Question 6

what diseases does hyperlipidaemia account for?

Answer 6

ischaemic heart disease

cerebrovascular disease- stroke

Question 7

how do drugs help to correct the ocygen supply and demand imbalance?

Answer 7

reduce heart rate
reduce myocardial contractility
reduced afterload

Question 8

what is the purpose of drug treatment for stable coronary artery disease?

Answer 8

relieve symptoms
halt the disease process
regression of the disease process
prevent myocardial infarction
prevent death

Question 9

what are the type of drug therapy’s?

Answer 9

Beta-adrenoceptor antagonists

Ivabradine

Calcium channel blockers

Nitrates

Potassium channel openers

Aspirin/Clopidogrel/Tigagrelor

Cholesterol lowering agents

Question 10

what are the function of beta blockers?

Answer 10

reversible antagonists of the B1 and B2

block the sympathetic system

Question 11

what are the three major determinants of myocardial; oxygen demand that beta blockers reduce?

Answer 11

heart rate
contractility
systolic wall tension

Question 12

what is Rebound Phenomena

Answer 12

sudden cessation of beta blocker therapy may precipitate MI

Question 13

what are contraindications of beta blockers

Answer 13

asthma
peripheral vascular disease
raynaulds syndrome
heart failure
bradycardia/heart block

Question 14

what are adverse drug reactions to beta blockers?

Answer 14

tiredness/fatigue
lethargy
impotence
bradycardia
bronchospasm

Question 15

what are th types of calcium channel blockers?

Answer 15

diltiazem, verapamil, amlodipine

Question 16

what are the functionof calcium channel blockers?

Answer 16

Prevent calcium influx into myocytes and smooth muscle lining arteries and atrerioles by blocking the L-Type calcium channel

Question 17

what are the function of rate limiting calcium channel blockers?

Answer 17

reduce heart rate and force of contraction

Question 18

what is the function of vasodilatinf ccbs

Answer 18

produce a reflex tachycardia

Question 19

what are contraindications of calcium channel blockers?

Answer 19

Evidence that the use of rapidly acting vasodilatatory-CCBs (nifedipine) may precipitate acute MI or stroke
Post MI
May increase morbidity and mortality in patients with impaired LV function
Unstable angina
Evidence that dihydropyridines may increase infarction rate and death in the unstable patient

Question 20

what are adverse drug reactions of adverse drug reactions?

Answer 20

ankle oedema
headache
flushing
palpatations

Question 21

what are the three types of nitrovasodilators

Answer 21

glyceryl trinitrate
isosorbide mononitrate
isosorbide dinitrate

Question 22

what is the function of nitrovasodilators

Answer 22

relax almost all smooth muscle by releasing NO which then stimulates the release of cGMP which produces smooth muscle relaxation

Question 23

how does nitrates relieve angina?

Answer 23

Arteriolar dilatation and so reducing cardiac afterload and thus myocardial work and oxygen demand

Peripheral venodilatation and so reducing venous return, cardiac preload and thus myocardial workload

Relieving coronary vasospasm

redistributing myocardial blood flow to ischaemic areas of the myocardium

Question 24

what is GTN used for?

Answer 24

Used for the rapid treatment of angina pain.
To avoid first pass metabolism is given by the sublingual route.
May be used frequently and prophylactically

Question 25

what is the use of oral nitrates?

Answer 25

Commonly given as a once a day sustained release formulation Used for prophylaxis

Question 26

what is the use of intravenous nitrates?

Answer 26

the main stay in the treatment of unstable angina where they are used in combination with heparin

Question 27

what is the function of ivabradine?

Answer 27

selective sinus node channel inhibitor slows the diastolic depolarisation slope of the SA node results in a reduction in heart rate

Question 28

what is the function of ranolazine?

Answer 28

Ranolazine inhibits persistent or late inward sodium current (INa) in heart muscle in a variety of voltage gated sodium channels. Inhibiting that current leads to reductions in intracellular calcium levels. This in turn leads to reduced tension in the heart wall, leading to reduced oxygen requirements for the muscle. 

Question 29

what are anti platelet agents?

Answer 29

low dose aspirin

Question 30

when would you give anti platelets

Answer 30

in adults unable to tolerate or with a contra-indication to the use of beta-blockers - or in combination with beta-blockers in patients inadequately controlled with an optimal beta-blocker dose.

Question 31

what is the most common cause of admission with a GI bleed?

Answer 31

low dose aspirin

Question 32

whats the function of clopidogrel

Answer 32

Inhibits ADP receptor activated platelet aggregation Prevention of atherosclerotic events in PVD Acute coronary syndrome

Question 33

what is the function of cholesterol lowering agents?

Answer 33

These are HMG CoA Reductase Inhibitors which are the most effective cholesterol lowering agents

Question 34

what is the treatment regimen for coronary artery disease? (ischaemic heart disease?)

Answer 34

``` Beta blocker Rate limiting CCB Dihydropiridine CCB Ivabradine/ Ranolazine Aspirin Statin Long acting Nitrate Nicorandil Refer for cardiology work up for possible stenting ```

Question 35

what should be used for first line therapy for stable angina?

Answer 35

beta blockers

Question 36

what should you use if beta blcokers does not releieve symptoms?

Answer 36

calcium channel blockers should be added

Question 37

what should patients receieve if they have stable angina as a result of atherosclerosis?

Answer 37

long term standard aspirin and statin therapy

Question 38

what are drugs for secondary prevention of CVD?

Answer 38

aspirin ace inhibitors statin treatment for high blood pressure