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Cardiovascular System > SIHD and Angina - Therapy > Flashcards

SIHD and Angina - Therapy Flashcards

1
Q

Define acute coronary syndromes (ACS)

A
  • AMI

- Unstable angina pectoris

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2
Q

Name the medication used to treat angina

A

Rate-limiting;

  • Beta-adrenoreceptor antagonists
  • Ivabridine
  • CCB

Vasodilators;

  • CCB
  • Nitrates (oral, sublingual)

Others;

  • Potassium channel openers
  • Aspirin/clopidogrel/tigragelor (platelet aggregation inhibitors)
  • Cholesterol lowering agents: MHA CoA reductase inhibitors, fibrates
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3
Q

Define supply ischaemia

A

Ischaemia at rest.

  • Coronary artery diameter and tone
  • Collateral blood flow
  • Perfusion pressure
  • HR (duration of diastole)
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4
Q

Describe the ways drugs can decrease myocardial demand for oxygen (i.e. treatment for angina)

A
  • Decrease HR
  • Decrease myocardial contractility
  • Reduce afterload
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5
Q

Define demand ischaemia

A

Ischaemia during stress.

  • HR
  • Systolic BP
  • Myocardial wall stress/contractility

Treat with beta blockers, CCB.

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6
Q

Define supply ischaemia

A

Ischaemia at rest.

  • Coronary artery diameter and tone
  • Collateral blood flow
  • Perfusion pressure
  • HR (duration of diastole)

Treat with nitrates, CCB.

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7
Q

Define beta blockers

A
  • Reversible antagonists
  • Can be cardioselective (only act on beta-1 receptors)
  • Block sympathetic system
  • Decrease HR, contractility and wall tension
  • Improve perfusion of subendocardium by increase duration of diastole
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8
Q

Define beta blockers

A
  • Reversible antagonists
  • Can be cardioselective (only act on beta-1 receptors)
  • Block sympathetic system
  • Decrease HR, contractility and wall tension
  • Decrease CO, BP
  • Improve perfusion of subendocardium by increase duration of diastole
  • Protect cardiomyocytes from oxygen free radicals formed during ischaemic episodes
  • Can increase exercise threshold
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9
Q

Define rebound phenomena

A

Sudden cessation of beta blockers can cause MI.

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10
Q

Define the contraindications of beta blockers

A
  • Asthma
  • Peripheral vascular disease
  • Raynauds syndrome
  • Heart failure: dependent on sympathetic drive
  • Bradycardia/heart block
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11
Q

Define the adverse drug reactions of beta blockers

A
  • Fatigue/lethargy
  • Impotence
  • Bronchospasm
  • Bradycardia
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12
Q

Define the drug-drug interactions of beta blockers

A
  • Hypotension with other hypotensive agents
  • Bradycardia with other rate-limiting drugs
  • Cardiac failure with other negative inotropic agent
  • Exaggerate/mask hypoglycaemic drugs
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13
Q

Define CCBs

A
  • Rate-limiting: reduce HR, contraction
  • Vasodilators: may produce reflex tachycardia
  • Reduce tone –> vasodilation –> reduce afterload
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14
Q

Define the contraindications of CCBs

A
  • Vasodilators: may cause AMI or stroke
  • Post-MI: may impair LV function
  • Unstable angina: may increase MI, death
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15
Q

Define the adverse drug reactions of CCBs

A
  • Ankle oedema
  • Headache
  • Flushing
  • Palpitations
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16
Q

Define nitrovasodilators (GTN, oral, IV)

A
  • Relax almost all smooth muscle
  • Arterial vasodilation: reduce afterload
  • Peripheral ventilation: reduce VR, preload
  • Relieve coronary vasospasm
  • Redistribute myocardial blood flow
17
Q

Define tolerance of nitrovasodilators

A
  • Can become tolerated quickly

- Treat by giving asymmetric doses of nitrate

18
Q

Define the adverse drug reactions of nitrovasdilators

A
  • Headaches

- Hypotension

19
Q

Define the new approach medications to angina

A
  • Metabolic modulation
  • Sinus node modulation
  • Late Na+ current inhibition
20
Q

Define nicorandil

A
  • Activate ATP-sensitive K+ channels
  • Entry of K+ inhibits Na+ influx –> negative inotropic action
  • Ischaemic preconditioning –> cardioprotective effect
21
Q

Define ivabridine

A
  • Sinus node inhibitor (rate-limiting)

- Slows diastolic depolarisation, reduces HR

22
Q

Define ranolazine

A
  • Late Na+ current inhibiton

- Reduced wall tension

23
Q

Define anti-platelet agents

A

Low dose aspirin (75-150mg);

  • Inhibits thromboxane production: platelet aggregation and vasoconstriction
  • Only reduces CAD outcome if HR >70bpm
  • Use for people who can’t’ take beta blockers
  • Or in combo with BB if it isn’t that effective
  • Most common cause of admission with GI bleed
24
Q

Define clopidogrel

A
  • Inhibits ADP receptor-activated platelet aggregation
  • Prevents atherosclerotic events in PVD
  • Treat ACS
  • Same incidence of bleeding as aspirin
25
Q

Define the treatment regimen for angina

A
  • Beta blocker
  • Rate-limiting CCB
  • Dihydropiridine CCB (vasodilator, long-acting)
  • Ivabridine (sinus node inhibitor)/Ranolazine (late Na+ current inhibitor)
  • Aspirin (anti-platelet)
  • Statin (cholesterol-lowering agent)
  • Long acting nitrate
  • Nicorandil (K+ channel opener)
  • Refer to cardiology

Cardiovascular System (26 decks)

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