Stable Ischaemic Heart Disease and Angina Therapy Flashcards

1
Q

what are the risk factors for SIHD and angina?

A
> hypertension
> smoking
> hyperlipidaemia
> hyperglyaemia
> male
> post-menopausal females
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2
Q

what is the purpose of drug treatment?

A
> relieve symptoms
> halt disease process
> regress the disease process
> prevent myocardial infarction
> prevent death
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3
Q

in an atheroma plaque what layer of artery is affected the most?

A

the intimal area

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4
Q

how does stable angina arise?

A

a mismatch between myocardial blood/oxygen supply and demand

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5
Q

how do drugs correct the supply and demand imbalance of oxygen in the myocardium?

A
Decrease myocardial oxygen demand:
> reduction of the heart rate
> reduction of the myocardial contractility
> reduction of afterload
Increase supply of oxygen to myocardium
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6
Q

name 2 beta blocker used

A

> bisprolol

> atenolol

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7
Q

what are beta blockers?

A

reversible antagonists for beta1 and 2 receptors

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8
Q

what three things do beta blockers decrease?

A

> heart rate
contractility
systolic wall tension

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9
Q

how do beta blockers improve perfusion of the sub-endocardium

A

by increasing diastolic perfusion time

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10
Q

what do beta blockers protect cardiomyocytes from during ischemic episodes?

A

oxygen free radicals

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11
Q

how do beta blocker increase the threshold at which angina occurs?

A

they reduce the heart rate, force of contraction and blood pressure so the balance point at which demand for oxygen outstrips the supply.

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12
Q

what is rebound phenomena?

A

sudden cessation of beta blocker therapy may precipitate myocardial infarction

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13
Q

what are the contraindications for beta blockers?

A
> asthma
> peripheral vascular disease
> raynauds syndrome
> heart failure (dependant on sympathetic system)
> bradycardia/heart block
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14
Q

what adverse drug reaction can occur due to beta blockers?

A
> tiredness
> lethargy
> impotence
> bradycardia
> bronchospasm
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15
Q

what drug-drug interactions with beta blockers can cause hypotension?

A

other hypotensive agents

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16
Q

what drug-drug interactions with beta blockers cause bradycardia?

A

other rate limiting drugs such as verapamil or diltiazem

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17
Q

what drug-drug interactions with beta-blocker cause cardiac failure?

A

negatively inotropic agents such as verapamil, diltiazem or disopyramide

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18
Q

what drug-drug interactions with beta blockers agonise antihypertensive actions?

19
Q

what are the drug drug interaction of beta-blockers and insulin/oral hypoglycaemics?

A

they exaggerate and mask hypoglycaemic actions of insulin or oral hypoglycaemics

20
Q

name three calcium channel blocker

A

> diltiazem
verapamil
amlodipine

21
Q

what is the action of calcium channel blockers?

A

they prevent calcium influx into myocytes and smooth muscle lining the arteries and arterioles by blocking the l-type calcium channels. this reduces vascular tone, afterload, heart rate and myocardial oxygen requirements.

22
Q

what are the effects of rate limiting calcium channel blocker?

A

they reduce heart rate and force of contraction

23
Q

what are the effects of vasodilating calcium channel blockers

A

they produce a reflex tachycardia

24
Q

why should you never use nifedipine immediate release?

A

there is evidence that the use of rapidly acting vasodilatory CCBs may precipitate and MI or stroke

25
what are the contraindications of calcium channel blockers?
post MI (may increase morbidity and mortality) and unstable angina (increase infarction rate and death).
26
name some adverse drug reaction from calcium channel blockers
> ankle oedema > headache > flushing > palpitations
27
name three nitrovasodilators and their administration methods
> glyceryl trinitrate (sublingual, buccal, transdermal) > isosorbide mononitrate (sustained release formulation, tablets) > isosorbide dinitrate (sustained release formulation, tablets)
28
describe the pharmacology of nitrovasodilators
they relax almost all smooth muscle by releasing NO which then stimulates the release of cGMP which produces smooth muscle relaxation.
29
what is the effect of nitrovasodilators on preload and afterload?
they reduce preload and afterload
30
how do nitrates relieve angina?
> arteriolar dilation (reduce cardiac afterload) > peripheral veno-dilation (reducing venous return, afterload) > relieves coronary vasospasm > redistributes myocardial blood flow to ischaemic areas
31
what nitrate is used for prophylaxis?
oral nitrates given as a once a day sustained release
32
what is used to rapidly treat angina pain?
GTN
33
what is the main treatment of unstable angina?
intravenous nitrates used in combination with heparin
34
how can tolerance to nitrates be overcome?
> giving asymmetric doses of nitrate 8am and 2pm | > using a sustained release preparation which incorporates a nitrate free period
35
what adverse drug reactions can occur with nitrates?
> headache | > hypotension: GTN syncope
36
what does nicorandil activate?
silent potassium channels
37
what is the affect of nicorandil?
it allows entry of potassium into cardiac myocytes inhibiting the calcium influx, having a negative inotropic action.
38
what problems arise due to nicorandil?
bowel ulceration
39
what channel does ivabradine inhibit?
sinus node If channel
40
what is the affect of ivabradine?
it slows diastolic depolarisation slope of the SA-node resulting in a reduction in heart rate and myocardial oxygen demand
41
what does aspirin inhibit?
platelet thromboxane production
42
what are the indications for aspirin?
> adults who are unable to tolerate/with a contraindication for the use of beta blockers > in combination wit beta blockers in patients inadequately controlled with an optimal beta-blocker dose
43
what does clopidogrel inhibit?
ADP receptor activated platelet aggregation
44
name three HMG CoA reductase inhibitors
> simvastatin > pravastatin > atorvastatin