Stable ischemic heart disease and angina – therapy Flashcards
What does drug therapy aim to achieve in treating stable ischemic heart disease and angina
Decrease myocardial oxygen demand by reducing cardiac workload
therefore increasing oxygen supply
How does drug therapy reduce myocardial oxygen demand and cardiac workload
Reduce heart rate
Reduce myocardial contractility
Reduce afterload
What is the different drug therapies used
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
What are the drugs in therapy used to halt disease progression
Aspirin
ACE Inhibitors
Statin treatment
High blood pressure treatment
What treatment therapy is given to all patients with stable angina due to atherosclerotic disease
Long term standard aspirin and statin therapy
What is the 1st line treatment recommend for relief go angina symptoms
Short acting nitrates (eg GTN) beta blockers (Bisoprolol, Atenolol)
When also would calcium channel blockers be used in first line treatment
Used in combination with Beta blockers if angina symptoms worsen
Consider if have a intolerance to beta blockers
Use
What is used is as a second line treatment of angina relief
IK channel blockers (Ranolazin/Ivabradine)
Long-acting nitrates
K channel blockers (Nicorandil)
Fatty acid oxidation inhibitor -Trimetazidine
Angioplasty:
PCI- stenting or CABG
What is used as an alternative case of aspirin intolerance
Clopidogrel
When is it recommended to use ACE inhibitors as a secondary prevention
If there is a presence of another conditions
eg. heart failure, hypertension or diabetes
What is the action and benefit of beta blockers, 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
How do they beta blockers increase the exercise threshold to which angina will occur
As lower overall blood pressure, therefore reset threshold
What is the protective function of beta blockers
protect cardiomyocytes from oxygen free radicals formed during ischaemic episodes
When does contradictions occur in beta blocker therapy,
not recommended use
Asthma
Peripheral Vascular Disease - Relative contraindication
Raynauds Syndrome
Heart failure - Those patients who are dependent on sympathetic drive
Bradycardia / Heart block
What is the possible adverse drug reactions of beta blockers
fatigue Impotence Bradycardia Bronchospasm Rebound – MI
What is the drug interaction between Beta blocker and:
- Hypotensive agents
- Rate limiting drugs
- Negatively ionotropic agents
- Hypotension
- Bradycardia
- Cardiac failure
What is the two actions of calcium channel blockers
Rate limiting-reducing myocardial demand
(Dilitazem, veramipril)
Vasodilating - coronary vasodilations (reduces afterload)
(amlodipine)
How does CCB acts as a rate limiting drug
Prevent calcium influx into myocytes reducing:
Contractiond
vascular tone
OVERALL = REDUCES MYOCARDIAL DEMAND
When should you never use nifedipine CCB immediate release (rapid acting vasodilators)
why?
Post MI (with impaired LV function) or Unstable angina (increase infarction rate and + death)
may precipitate a stroke or MI
What is the adverse drug reactions of CCB
Ankle oedema
Headache
Flushing
Palpitations
reflex tachycardia
Name three drug nitrovasodilators
Glyceryl trinate GTN
Isosorbide monoitrate
Isosorbide dinitrate
What is the different methods of GTN administration
and what is the benefit of GTN
Sublingual / Buccal / Transdermal
Bypass First pass metabolism
rapid treatment
used frequently and prophylactically
What is the purpose of Isosorbide monoitrate
Isosorbide dinitrate treatment and how is it administrated
Prophylaxis
sustained release formation
one tablet given once daily
How does ntirovasodilators relieve angina
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
