Stable angina therapy

Question 1

what are different drug therapies given for stable angina?

Answer 1

beta adrenoreceptor antagonist
ivabradine
calcium channel blockers
nitrates
potassium channel openrs
aspirin/clopidogrel/trigagrelor
statins

Question 2

name 3 rate limiting drugs used to treat stable angina.

Answer 2

beta adrenoraceptor antagonists
Ivabradine
calcium channel blockers

Question 3

name 2 vasodilator drugs used to treat stable angina.

Answer 3

calcium channel blockers

nitrates i.e. GTN

Question 4

name 2 common beta blocker drugs used.

Answer 4

bisoprolol and atenolol

Question 5

what is the name for beta blockers which only inhibit the b1 receptors?

Answer 5

cardioselective

Question 6

how do beta blockers help reduce anginal symptoms?

Answer 6

angina is caused by lack of oxygen supply to the myocardium.
beta blockers allow improved perfusion to the sub endocardiumm by increasing diastolic perfusion time.
the heart is relaxed in diastole so the vessels are dilated this more blood flow.

Question 7

beta blockers work by decreasing which 3 major determinants of myocardial oxygen demand?

Answer 7

heart rate
contractility
systolic wall tension

Question 8

what does sudden cessation from beta blockers cause?

Answer 8

rebound phenomenon

Question 9

describe how rebound phenomenon occurs.

Answer 9

sudden cessation of beta blockers can cause a drop in blood pressure and so the heart rate rapidly increases to compensate
this may precipitate a myocardial infarction

Question 10

who are at risk of beta blocker rebound phenomenon?

Answer 10

patients with angina and men over 50 years receiving BB for other reasons

Question 11

what are the contraindications for beta blockers?

Answer 11

asthma
peripheral vascular disease
raynauds syndrome
heart failure
bradycardi/heart block

Question 12

what are the adverse reactions from beta blockers?

Answer 12

tiredness/fatigue
lethargy
impotence
bradycardia
bronchospasm

Question 13

what can result if beta blockers are used with veramapil or diltiazem?

Answer 13

bradycardia

Question 14

how do calcium channel blockers work?

Answer 14

they prevent calcium influx int myocytes and smooth muscles lining arteries and arterioles by blocking the L-type calcium channel

Question 15

what are 2 rate limiting calcium channel blockers?

Answer 15

diltiazem and verapamil

Question 16

what type of drug is nidfedipine?

Answer 16

calcium channel blocker

Question 17

what contraindications are there for nifedipine?

Answer 17

nifedipine should never be used for immediate release

evidence that it may perpetuate an acute MI or stroke

Question 18

name 2 vasodilating calcium channel blockers.

Answer 18

amlodipine and nifedipine

Question 19

how does CCB’s reduce myocardial work load?

Answer 19

they reduce vascular tone and reduce after load

Question 20

how does rate limiting CCB’s reduce myocardial oxygen requirements?

Answer 20

reduce the heart rate and the force of myocardial contraction

Question 21

what is the action of glyceryl trinitrate?

Answer 21

GTN is a vasodilator.
it relaxes almost all smooth muscle by releasing NO which then stimulates the release of cGMP which produces smooth muscle relaxation.

Question 22

how does nitrates reduce myocardial oxygen consumption?

Answer 22

by causing vasodilation from smooth muscle relaxation, nitrates reduce preload and after load which reduces oxygen consumption

Question 23

how does nitrates reduce preload?

Answer 23

it causes peripheral vasodilation and so reduces venous return and therefore preload

Question 24

what are oral nitrates used for?

Answer 24

prophylaxis
usually 1 tablet per day
tablets are a sustained released formulation

Question 25

when is IV nitrates used and what with?

Answer 25

IV nitrates are used for treatment of unstable angina and are used in combination with heparin

Question 26

what is one of the common problems of nitrates?

Answer 26

tolerance to the effects of nitrates can develop rapidly

Question 27

how can tolerance of nitrate be overcome?

Answer 27

giving asymmetric doses of nitrate i.e. 8am then 2pm

and/or using a sustained preparation which therefore means the patient has a nitrate free period

Question 28

what are the adverse drug reactions from nitrates?

Answer 28

headache

hypotension - GTN syncope

Question 29

describe how nicorandil works .

Answer 29

nicorandil activates ischaemic pre-conditioning.
it activates ATP sensitive potassium channels.
the entry of potassium into cardiac myoytes inhibits calcium influx and so has a negative inotropic action - reducing heart rate

Question 30

what type of drug is Ivabradine?

Answer 30

ivabradine is a selective sinus node If channel inhibitor

Question 31

how does ivabradine reduce heart rate?

Answer 31

ivabradine inhibits the sinus node If channel which slows the diastolic depolarisation slop of the SA node.

Question 32

what are the new drug approaches/treatments to treat ischaemia?

Answer 32

metabolic modulation (trimetazidine)
sinus node inhibition (ivabradine)
pre conditioning (nicorandil)
late Na current inhibition (ranolazine)

Question 33

what are the indications of aspirin for CAD?

Answer 33

aspirin is used in adults who are unable to tolerate or have a contraindication to the use of beta blockers
or are used in combination with beta blockers in patients who are adequately controlled with optimal beta blocker use

Question 34

what is the main adverse reaction from aspirin?

Answer 34

GI bleed

Question 35

what type of drugs are HMG CoA reductase inhibitors?

Answer 35

statins