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Coronary Heart Disease > treatment of SCAD > Flashcards

treatment of SCAD Flashcards

1
Q

What is the protype of nitrates/nitrites?

A

nitroglycerin (GTN)

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2
Q

What do nitrates directly act on and what do they do to them?

A

blood vessels

vasodilation (widen blood vessels)

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3
Q

What is a prodrug?

A

the drug needs to be converted in vivo to the biologically active metabolite

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4
Q

What is the active metabolite of nitrates?

A

NO nitric oxide

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5
Q

What does NO activate?

A

guanylate cyclase

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6
Q

Wat does guanylate cyclase do?

A

convetrs GTP to cGMP
which activates PKG
causes vasorelaxation

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7
Q

What group in NO interact?

A

thiol groups

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8
Q

What is the main anti-anginal effect of nitrates?

A
  1. venodilation
  2. peripheral arterial/arteriolar dilation
  3. coronary vasodilation
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9
Q

Clinical uses of nitrates

A
  • relief of angina attacks

- treats chronic angina

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10
Q

Adverse effects of nitrates

A
  • headaches
  • postural hypotension and syncope
  • reflex tachycardia and increased myocardial contractility
  • tolerance
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11
Q

How do you develop tolerance to nitrates?

A
  • depletion of thiol groups

- physical adaptation

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12
Q

Recommendations for nitrate therapy

A
  1. begin with small dose
  2. establish threshold that achieves effect
  3. use lease amount needed
  4. avoid sustained action formulations
  5. plan to have a nitrate free interval of 8-10hrs
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13
Q

2 structural analogues of beta adrenoceptor antagonists

A
  • analogues

- isoprenaline

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14
Q

Protypes of beta adrenoceptor

A

propranolol

atenolol

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15
Q

What is the pharmacological action of beta blockers?

A

antagonise the effects of the sympathetic nervous activation

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16
Q

2 classes of beta blockers

A
  • non selective

- beta 1 receptor selective

17
Q

Features of hepatic metabolism (beta blockers)

A
  • lipid soluble
  • completely absorbed from gut
  • metabolised in liver
  • variable bioavailability
  • short plasma 1/2 life
18
Q

Features of kidney metabolism (beta blockers)

A
  • water soluble
  • incompletely absorbed from gut
  • eliminated unchanged
  • less variable bioavailability
    longer 1/2 life
19
Q

Adverse effects of beta blockers

A
  • increase LV size
  • rebound phenomenon
  • bronchoconstriction
  • peripheral vasoconstriction
  • myocardial depression
  • mask signs of hypoglycaemia
  • sexual disfunction
  • CNS disturbances
20
Q

How do calcium channel blockers work?

A

inhibit Ca entry into cells via voltage gates calcium channels

21
Q

What cells do Ca channel blockers stop Ca entry into?

A

cardiac muscle cells
nodal cells
conducting cells

22
Q

What effects do Ca blockers have on the heart?

A

decrease cardiac contractility

reduce HR

23
Q

What vascular effects do Ca blockers have?

A

blocks Ca into arterioles which causes arteriolar dilation

24
Q

What does peripheral vasodilation by Ca blockers do?

A

reduce SVR which reduces arterial BP

25
Q

What does coronary dilation by Ca blockers do?

A
  • increases BF

- reversal and prevention of spasm

26
Q

How do Ca blockers give anti-anginal effects?

A
  • reduce myocardial O2 demand

- increase myocardial BF

27
Q

What 2 types of angina are Ca blockers used to treat?

A

chronic stable and variant angina

28
Q

effects of Ca channel blockers

A 
cardiodepression
hypotension
atrioventricular block
peripheral edema
headache
constipation
29
Q

3 other drugs used to treat SCAD

A
  • K channel openers
  • sinus node inhibitors
  • late Na current blockers
30
Q

2 procedures to treat SCAD

A
  • PCI

- CABG

31
Q

PCI

A

percutaneous coronary intervention

32
Q

CABG

A

coronary artery bypass graft

33
Q

2 types of PCI

A
  • balloon angioplasty

- coronary stenting

34
Q

2 types of stents

A
  1. bare metal stents (BMS)

2. drug eluting stents (DES)

Coronary Heart Disease (14 decks)

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