Stable angina therapy

Question 1

hyperlipidaemia - how does it cause damage to arteries?

Answer 1

blood has too many lipids (or fats), such as cholesterol and triglycerides

Atherosclerosis is the start

disease of the muscular arteries (not veins) - coronary and cerebral vessels

progressive deposition of cholesterol esters

Question 2

mortality due to ischaemic heart disease is usually due to what?

Answer 2

MI

Question 3

mortality due to cerebrovascular disease is usually due to what?

Answer 3

stroke

Question 4

what do lesions in atherosclerosis start as

Answer 4

fatty streaks

Question 5

what do fatty streaks develop into

Answer 5

fibrous plaques - more advanced/established

-project into the arterial lumen and cause reduced blood flow

Question 6

where do fatty streaks form

Answer 6

in high pressure areas so muscular arteries NOT veins

Question 7

what happens when plaques rupture

Answer 7

releases thrombogenic material
triggers clotting cascade- platelets adhere to exposed collagen

The plaque may heal, burying the thrombus into the vessel wall and causing the plaque to grow, or the thrombus may embolise distally

Question 8

how can drugs help to correct imbalance of supply/demand of O2

Answer 8

decreasing myocardial oxygen demand by reducing cardiac workload

so reduce heart rate, reduce myocardial contractility, reduce afterload

by reducing heart rate, the heart stays longer in diastole and you get improved perfusion through the myocardium and better O2 supply

Question 9

purpose of drug treatment (5)

Answer 9

relieve symptoms
halt the disease process
regression of the disease process
prevent MI
prevent death

Question 10

what rate limiting (reduce heart rate) drugs are used for stable angina?

Answer 10

beta blockers (beta adrenoceptor antagonists)

ivabradine

Ca2+ channel blockers

Question 11

what vasodilators are used in therapy for stable angina

Answer 11

Ca2+ channel blockers

Nitrates like GTN - quick relief of symptoms - oral, sublingual

Question 12

Ca2+ channel blockers can fall under which types of drug therapies?

Answer 12

rate limiting and vasodilators

Question 13

Other than rate limiting and vasodilators what other types of drugs are used for stable angina

Answer 13

Potassium channel openers - induce relaxation of vascular smooth muscle

Anti-platelets Aspirin/Clopidogrel

Statins - cholesterol lowering agents

Question 14

how does ivabradine work

Answer 14

it reduces heart rate by inhibiting the pacemaker current/slowing the depolarisation in the SA node

can cause issues in people with previous heart problems

reduces fatal and nonfatal myocaridial infarction if heart rate is higher than or = to 70

Question 15

beta blockers:- types, how they work

Answer 15

bisoprolol, atenolol

Beta blockers are reversible antagonists of the beta 1 (in the heart) and beta 2 (in the lungs) receptors

Newer drugs are cardioselective acting primarily on the beta 1 receptors

Block the sympathetic system

Question 16

what 3 major determinants of myocardial O2 demand do beta blockers decrease?

Answer 16

heart rate
contractility
systolic wall tension

Question 17

why must you not suddenly stop taking beta blockers?

Answer 17

it could cause MI esp if patient has angina, or is male or >50

Question 18

When should you not use a beta blocker

Answer 18

if a patient’s heart failure is unstable - it could kill them

if they have asthma, peripheral vascular disease
Raynauds syndrome

bradycardia - slow it down too much

Question 19

Raynauds syndrome

Answer 19

disease causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress.

Smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas

Question 20

Adverse drug reactions with beta blockers (6)

Answer 20

Tiredness /fatigue
Lethargy
Impotence- helpless
Bradycardia
Bronchospasm

Rebound – suddenly stopping a beta blocker then you can become highly anxious – exaggerated response to A/NA. And may cause MI. Stop using them over the course of a week

Question 21

drug-drug interactions

Answer 21

hypotension when used with other hypotensive agents

bradycardia when used with other rate limiting drugs

cardiac failure when used with negatively inotropic (modifying the force or speed of contraction of muscles) agents

NSAIDs antagonise antihypertensive actions

Question 22

Ca2+ channel blockers:- types, how they work

Answer 22

DILTIAZEM, VERAPAMIL, AMLODIPINE

Prevent calcium influx into myocytes and smooth muscle lining arteries and atrerioles by blocking the L-Type calcium channel
reduce vascular tone and produce vasodilation and reduce afterload

rate limiting - like diltiazem and verapamil also reduce heart rate and force of contraction

vasodilatiing - amlodipine - may produce a reflex tachycardia

Question 23

adverse drug reactions with Ca2+ channel blockers

Answer 23

ankle oedema
headache
flushing
palpitation

Question 24

GTN therapy

Answer 24

when patients present with angina they are put on GTN - doesn’t do anything for morbidity or mortality but relieves symptoms

it dilates arteries and veins by releasing Nitric oxide which then stimulates release of cGMP - smooth muscle relaxation

reduces preload and afterload - reduces O2 consumption

Question 25

what are IV nitrates used with?

Answer 25

heparin (anticoagulant)

Question 26

ADRs for nitrates?

Answer 26

headache

hypotension - GTN syncope

Question 27

what is Nicorandil and when is it used

Answer 27

drug used to prevent or reduce angina associated with heart disease.
Used in adults who cannot take beta-blockers or Ca2+ antagonists

works similarly to nitrates - releases NO which causes vasodilation

Question 28

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

Answer 28

low dose aspirin - use clopidogrel if they can’t have aspirin less risk of bleeding

Question 29

statins are used for what

Answer 29

lowering cholesterol

statins stabilise atheromatous plaques in arteries and stop them fissuring and releasing thrombogenic material – they interfere in immunological processes going on with plaques

Question 30

first line for long term therapy for relief of stable angina?

Answer 30

beta blockers - reduce the O2 demand of the heart

Question 31

when adequate control of anginal symptoms is not achieved with beta blockade what should be added?

Answer 31

calcium channel blocker

Question 32

if the patient’s symptoms are not controlled by beta blocker or Ca2+ channel blocker or the combo together then what should be used?

Answer 32

then use ivabramide (reduces the pacemaker potential specifically in SA node) or ranolizine (an anti-anginal that increases blood flow to help the heart)

Question 33

All patients with stable angina due to atherosclerotic disease should receive what therapy in the long term?

Answer 33

standard aspirin

statin therapy

Question 34

drugs for secondary prevention of CVD

Answer 34

aspirin - inhibits platelet aggregation
ACE inhibitors - decreases MAP
statins - reduce cholesterol level
high blood pressure treatment

Question 35

what is used for immediate therapy for an onset of angina?

Answer 35

GTN spray for relief of symptoms