sihd and angina therapy Flashcards
whats the most common cause of death in pre-retirement males?
ischaemic heart disease
what are acute coronary syndromes?
myocardial infarction- STEMI or NSTEMI
unstable angina pectoris
what are stable coronary artery disease?
angina pectoris
silent ischaemia
what are risk factors for stable coronary artery disease?
hypertension smoking hyperlipidaemia hyperglycaemia male post-menopausal females
why do stable coronary artery diseases arise?
as a result of a mismatch between myocardial blood/ oxygen supply and demand
what diseases does hyperlipidaemia account for?
ischaemic heart disease
cerebrovascular disease- stroke
how do drugs help to correct the ocygen supply and demand imbalance?
reduce heart rate
reduce myocardial contractility
reduced afterload
what is the purpose of drug treatment for stable coronary artery disease?
relieve symptoms halt the disease process regression of the disease process prevent myocardial infarction prevent death
what are the type of drug therapy’s?
Beta-adrenoceptor antagonists
Ivabradine
Calcium channel blockers
Nitrates
Potassium channel openers
Aspirin/Clopidogrel/Tigagrelor
Cholesterol lowering agents
what are the function of beta blockers?
reversible antagonists of the B1 and B2
block the sympathetic system
what are the three major determinants of myocardial; oxygen demand that beta blockers reduce?
heart rate
contractility
systolic wall tension
what is Rebound Phenomena
sudden cessation of beta blocker therapy may precipitate MI
what are contraindications of beta blockers
asthma peripheral vascular disease raynaulds syndrome heart failure bradycardia/heart block
what are adverse drug reactions to beta blockers?
tiredness/fatigue lethargy impotence bradycardia bronchospasm
what are th types of calcium channel blockers?
diltiazem, verapamil, amlodipine
what are the functionof calcium channel blockers?
Prevent calcium influx into myocytes and smooth muscle lining arteries and atrerioles by blocking the L-Type calcium channel
what are the function of rate limiting calcium channel blockers?
reduce heart rate and force of contraction
what is the function of vasodilatinf ccbs
produce a reflex tachycardia
what are contraindications of calcium channel blockers?
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
what are adverse drug reactions of adverse drug reactions?
ankle oedema
headache
flushing
palpatations
what are the three types of nitrovasodilators
glyceryl trinitrate
isosorbide mononitrate
isosorbide dinitrate
what is the function of nitrovasodilators
relax almost all smooth muscle by releasing NO which then stimulates the release of cGMP which produces smooth muscle relaxation
how does nitrates relieve angina?
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
what is GTN used for?
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
what is the use of oral nitrates?
Commonly given as a once a day sustained release formulation
Used for prophylaxis
what is the use of intravenous nitrates?
the main stay in the treatment of unstable angina where they are used in combination with heparin
what is the function of ivabradine?
selective sinus node channel inhibitor
slows the diastolic depolarisation slope of the SA node
results in a reduction in heart rate
what is the function of ranolazine?
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.
what are anti platelet agents?
low dose aspirin
when would you give anti platelets
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.
what is the most common cause of admission with a GI bleed?
low dose aspirin
whats the function of clopidogrel
Inhibits ADP receptor activated platelet aggregation
Prevention of atherosclerotic events in PVD
Acute coronary syndrome
what is the function of cholesterol lowering agents?
These are HMG CoA Reductase Inhibitors which are the most effective cholesterol lowering agents
what is the treatment regimen for coronary artery disease? (ischaemic heart disease?)
Beta blocker Rate limiting CCB Dihydropiridine CCB Ivabradine/ Ranolazine Aspirin Statin Long acting Nitrate Nicorandil Refer for cardiology work up for possible stenting
what should be used for first line therapy for stable angina?
beta blockers
what should you use if beta blcokers does not releieve symptoms?
calcium channel blockers should be added
what should patients receieve if they have stable angina as a result of atherosclerosis?
long term standard aspirin and statin therapy
what are drugs for secondary prevention of CVD?
aspirin
ace inhibitors
statin
treatment for high blood pressure
