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1st year systems > sihd and angina therapy > Flashcards

sihd and angina therapy Flashcards

1
Q

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

A

ischaemic heart disease

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2
Q

what are acute coronary syndromes?

A

myocardial infarction- STEMI or NSTEMI

unstable angina pectoris

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3
Q

what are stable coronary artery disease?

A

angina pectoris

silent ischaemia

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4
Q

what are risk factors for stable coronary artery disease?

A 
hypertension
smoking
hyperlipidaemia
hyperglycaemia
male
post-menopausal females
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5
Q

why do stable coronary artery diseases arise?

A

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

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6
Q

what diseases does hyperlipidaemia account for?

A

ischaemic heart disease

cerebrovascular disease- stroke

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7
Q

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

A

reduce heart rate
reduce myocardial contractility
reduced afterload

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8
Q

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

A 
relieve symptoms
halt the disease process
regression of the disease process
prevent myocardial infarction
prevent death
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9
Q

what are the type of drug therapy’s?

A

Beta-adrenoceptor antagonists

Ivabradine

Calcium channel blockers

Nitrates

Potassium channel openers

Aspirin/Clopidogrel/Tigagrelor

Cholesterol lowering agents

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10
Q

what are the function of beta blockers?

A

reversible antagonists of the B1 and B2

block the sympathetic system

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11
Q

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

A

heart rate
contractility
systolic wall tension

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12
Q

what is Rebound Phenomena

A

sudden cessation of beta blocker therapy may precipitate MI

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13
Q

what are contraindications of beta blockers

A 
asthma
peripheral vascular disease
raynaulds syndrome
heart failure
bradycardia/heart block
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14
Q

what are adverse drug reactions to beta blockers?

A 
tiredness/fatigue
lethargy
impotence
bradycardia
bronchospasm
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15
Q

what are th types of calcium channel blockers?

A

diltiazem, verapamil, amlodipine

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16
Q

what are the functionof calcium channel blockers?

A

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

17
Q

what are the function of rate limiting calcium channel blockers?

A

reduce heart rate and force of contraction

18
Q

what is the function of vasodilatinf ccbs

A

produce a reflex tachycardia

19
Q

what are contraindications of calcium channel blockers?

A

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

20
Q

what are adverse drug reactions of adverse drug reactions?

A

ankle oedema
headache
flushing
palpatations

21
Q

what are the three types of nitrovasodilators

A

glyceryl trinitrate
isosorbide mononitrate
isosorbide dinitrate

22
Q

what is the function of nitrovasodilators

A

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

23
Q

how does nitrates relieve angina?

A

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

24
Q

what is GTN used for?

A

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

25
Q

what is the use of oral nitrates?

A

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

26
Q

what is the use of intravenous nitrates?

A

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

27
Q

what is the function of ivabradine?

A

selective sinus node channel inhibitor
slows the diastolic depolarisation slope of the SA node

results in a reduction in heart rate

28
Q

what is the function of ranolazine?

A

Ranolazine inhibits persistent or late inward sodium current (INa) in heart musclein 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.

29
Q

what are anti platelet agents?

A

low dose aspirin

30
Q

when would you give anti platelets

A

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.

31
Q

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

A

low dose aspirin

32
Q

whats the function of clopidogrel

A

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

33
Q

what is the function of cholesterol lowering agents?

A

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

34
Q

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

A 
Beta blocker
Rate limiting CCB
Dihydropiridine CCB
Ivabradine/ Ranolazine
Aspirin
Statin
Long acting Nitrate
Nicorandil
Refer for cardiology work up for possible stenting
35
Q

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

A

beta blockers

36
Q

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

A

calcium channel blockers should be added

37
Q

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

A

long term standard aspirin and statin therapy

38
Q

what are drugs for secondary prevention of CVD?

A

aspirin
ace inhibitors
statin
treatment for high blood pressure

1st year systems (74 decks)

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