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Cardiovascular system SA > Stable ischemic heart disease and angina – therapy > Flashcards

Stable ischemic heart disease and angina – therapy Flashcards

1
Q

What does drug therapy aim to achieve in treating stable ischemic heart disease and angina

A

Decrease myocardial oxygen demand by reducing cardiac workload
therefore increasing oxygen supply

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2
Q

How does drug therapy reduce myocardial oxygen demand and cardiac workload

A

Reduce heart rate
Reduce myocardial contractility
Reduce afterload

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3
Q

What is the different drug therapies used

A

Cholestrol lowering agents
- Statins

ACE inhibitors

Aspirin/clopidogrel

B blockers

Ca Channel blockers

IK channel blockers

Nitrovasodilators

  • Short acting Nitrates - GTN
  • Long acting nitrates
  • K channel blockers

Fatty acid oxidation inhibitor

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4
Q

What are the drugs in therapy used to halt disease progression

A

Aspirin
ACE Inhibitors
Statin treatment
High blood pressure treatment

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5
Q

What treatment therapy is given to all patients with stable angina due to atherosclerotic disease

A

Long term standard aspirin and statin therapy

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6
Q

What is the 1st line treatment recommend for relief go angina symptoms

A 
Short acting nitrates (eg GTN) 
beta blockers (Bisoprolol, Atenolol)
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7
Q

When also would calcium channel blockers be used in first line treatment

A

Used in combination with Beta blockers if angina symptoms worsen

Consider if have a intolerance to beta blockers

Use

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8
Q

What is used is as a second line treatment of angina relief

A

IK channel blockers (Ranolazin/Ivabradine)
Long-acting nitrates
K channel blockers (Nicorandil)
Fatty acid oxidation inhibitor -Trimetazidine

Angioplasty:
PCI- stenting or CABG

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9
Q

What is used as an alternative case of aspirin intolerance

A

Clopidogrel

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10
Q

When is it recommended to use ACE inhibitors as a secondary prevention

A

If there is a presence of another conditions

eg. heart failure, hypertension or diabetes

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11
Q

What is the action and benefit of beta blockers, a

A

Reversible antagonist of Beta 1+2 receptors - blocking the sympathetic system:

Reduced myocardial demand

Increase diastolic perfusion time
- heart relaxed for longer increase blood flow to the myocardial

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12
Q

How do they beta blockers increase the exercise threshold to which angina will occur

A

As lower overall blood pressure, therefore reset threshold

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13
Q

What is the protective function of beta blockers

A

protect cardiomyocytes from oxygen free radicals formed during ischaemic episodes

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14
Q

When does contradictions occur in beta blocker therapy,

not recommended use

A

Asthma
Peripheral Vascular Disease - Relative contraindication
Raynauds Syndrome
Heart failure - Those patients who are dependent on sympathetic drive
Bradycardia / Heart block

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15
Q

What is the possible adverse drug reactions of beta blockers

A 
fatigue
Impotence
Bradycardia
Bronchospasm
Rebound – MI
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16
Q

What is the drug interaction between Beta blocker and:

  1. Hypotensive agents
  2. Rate limiting drugs
  3. Negatively ionotropic agents
A
  1. Hypotension
  2. Bradycardia
  3. Cardiac failure
17
Q

What is the two actions of calcium channel blockers

A

Rate limiting-reducing myocardial demand
(Dilitazem, veramipril)

Vasodilating - coronary vasodilations (reduces afterload)
(amlodipine)

18
Q

How does CCB acts as a rate limiting drug

A

Prevent calcium influx into myocytes reducing:
Contractiond
vascular tone
OVERALL = REDUCES MYOCARDIAL DEMAND

19
Q

When should you never use nifedipine CCB immediate release (rapid acting vasodilators)
why?

A 
Post MI (with impaired LV function) 
or 
Unstable angina (increase infarction rate and + death)

may precipitate a stroke or MI

20
Q

What is the adverse drug reactions of CCB

A

Ankle oedema
Headache
Flushing
Palpitations

reflex tachycardia

21
Q

Name three drug nitrovasodilators

A

Glyceryl trinate GTN
Isosorbide monoitrate
Isosorbide dinitrate

22
Q

What is the different methods of GTN administration

and what is the benefit of GTN

A

Sublingual / Buccal / Transdermal

Bypass First pass metabolism
rapid treatment
used frequently and prophylactically

23
Q

What is the purpose of Isosorbide monoitrate

Isosorbide dinitrate treatment and how is it administrated

A

Prophylaxis

sustained release formation
one tablet given once daily

24
Q

How does ntirovasodilators relieve angina

A

Relax all smooth muscle

  • causes arteriolar dilation/venodilation therefore reduces myocardial oxygen demand
  • Relieves coronary vasospasm
  • redistributes myocardial blood flow to ischaemic areas of the myocardium
25
Q

What is the purpose of nitrovasodialotes

A

Symptomatic to relieve angina

Doesn’t reduce mortality

26
Q

What is the adverse drug reactions of Nitrovasodilators

A

headache
Hypotension

GTN syncope -rapid reduction in blood pressure and cardiac return causes you to pass out

27
Q

When would you use intravenous nitrates

A

For Hospital treatment go unstable angina in combination with anticoagulant heparin

28
Q

How does K channel blocker nicroandil work

A

Activates CGMP

Pottasium channels open and potassium flows into the cells causing hyperpolorisation - this inhibits calcium influx

Relaxing vascular smooth muscle and decreasing the after load and preload on the heart and protects the myocytes

29
Q

How does trimetazdine act in the treatment of SCAD

A

Metabolic modulation

Inhibiting fatty acid oxidation in myocyctes

30
Q

How do IK channel blockers ivabradine and ranolazine work,

A

Selective snius node inhibitors that slow diastolic depolarisation of the SA node causing a late sodium inhibition

Decreases heart rate which reduces the overall myocardial oxygen demand

31
Q

When is it affective to use ivabradine and ranolazine

A

only effective in patiet with high heart rate to star with >70bpm

adults unable to tolerate beta blockers

Used in combination with controled optimal beta blocker dose

Fot symptomatic treatment

32
Q

Why is low dosage of 75-100mg aspirin used

A

Low does just as effective and reduces the last of GI bleed

33
Q

How does aspirin and clopidogrel work

A

Potent inhibit of platelet thromboxane production - preventing platelet aggravation and vasoconstriction

34
Q

What can be used in combination with aspirin

A

streptokinase

35
Q

When would you use clopidogrel over aspirin

A

If cant tolerate asthma

Has a lower change of GI bleed

36
Q

What is the three examples of cholesterol lowering agents

A

simvistatin
prevasatin
atrovastatin

37
Q

How do cholesterol lowering agents work

A

stabilise atheromatous plaque,

reduce inflammation in the atheroma

38
Q

What do statins prevent

A

Release of thrombus

Reducing the risk of MI or stroke

Cardiovascular system SA (43 decks)

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