THERAPY OF ANGINA

Question 1

physical factors affecting blood flow

Answer 1

coronary blood flow takes place during diastole, any effect on diastole will impact on this blood flow.
->reduction of diastolic aortica pressure/ increase of diastolic ventricular pressure, reduction of blood flow ( like stenosis of aortic valve.

Question 2

definition of Angina

Answer 2

ischemic chest pain due to single vessel stenosis or multiple vessels stenoses, reduction of blood flow and oxygen delivery to the heart tissue

Question 3

therapeutic aims of treatment of angina

Answer 3

restore balance between oxygen demand and supply of the heart:

1. reduction of cardiac workload
2. redistribution of coronary blood flow
3. reduction of coronary vasospasm
4. reduction of risk of acute event ( lifestyle changes)

Question 4

types of Angina

Answer 4

1. stable angina, no change of symptoms over months
2. unstable angina, pain at rest with no exertion, higher risk of CV events
3. variant angina

Question 5

beta adrenoreceptors antagonist

NAC

Answer 5

N. beta adrenaline receptor antagonist

A. block the binding of adrenaline to the beta 1 receptors

C. stop the adrenaline effect on increasing HR and Contractility, causing ⤓HR+contractility (how strong the heart contracts)+ afterload (how much blood left in the heart after a beat)

Question 6

classes of vasodilators

Answer 6

• direct-acting, CCB, Katp channel activators, nitrates
• indirect-acting

Question 7

CCB are distinct depending of the _________ on the calcium channel and the different type of _______ they act upon.

Answer 7

site of action, cardiomyocyte

Question 8

CCB act on the _____ channels, causing reduction of __________ and ____________ of iCA, they also act on ________________ relaxation, causing reduction of ________, cardiac _____ and _______

they are _____ administered and well absorbed, differet ______

generally ______ from S/E apart from nifedipine which can cause _______, flushing, _____, ankle swelling

Answer 8

L-type, calcium entry, reduction, smooth muscle, afterload, contractility, HR.

orally, half-life.

free

dizziness, hypotension

Question 9

therapeutic effect of Nitrates

Answer 9

1. venorelaxation and reduction of central venous pressure, reduce preload
2. large arteries relaxation, reduce central aortic pressure and afterload
3. coronary vasodilatation and increase in coronary blood flow
4. divert blood flow from normal to ischemic areas of the myocardium.

overall increase in oxygen content

Question 10

pharmacokinetics of Amyl nitrile, Nitroglycerine, Isosorbide mononitrate

Answer 10

• Amyl Nitrile, volatile liquid inhaled and absorbed in lungs, onset of action 30 sec, duration 3-5 min, used in acute angina attacks or cyanide poisoning
• Nitroglycerine, sublingual/transdermal/topical/iv/oral slow-release, peaks in 4 min, half-life 30 min, short shelf life
• Isosorbide Mononitrate, sublingual/oral, slow onset, long-acting 4 h, usually used for prevention of angina

Question 11

S/E OF NITRATES

Answer 11

• postural hypotension
• dizziness, headache
• reflex tachycardia when the supply overcomes the demand of oxygen
• tolerance to vasodilative effects due to low production of endogenous NO