Treatment of Stable Angina

Question 1

What is the difference between stable angina and acute coronary syndrome (ACS)?

Answer 1

stable angina symptoms are precipitated by physical exertion but are releived by rest

ACS symptoms appear at rest

Question 2

What are the possible causes of ACS?

Answer 2

vasospasm

unstable plaque rupture

Question 3

What is the characteristic ECG change seen in a patient with stable angina?

What does this indicate?

Answer 3

ST depression after exercise

indicates ischaemia

Question 4

What drug gives symptomatic relief from angina?

Answer 4

glyceryl trinitrate (GTN)

taken when symptoms appear

Question 5

What drugs can be taken as a preventative measure (prophylactically) against stable angina?

Answer 5

bisaprolol

beta-blockers

calcium-channel blockers

Question 6

What is the MOA of glycerol trinitrate?

Answer 6

• metabolised in the body to NO
• NO activates guanylyl cyclase in smooth muscle cells
• increase in cGMP which activates protein kinase G
• PKG activity prevents Ca²⁺ entry into smooth muscle cells
• coronary vessels dilate

Question 7

What is nitrate tachyphylaxis?

Answer 7

tolerence built up to the trug

higher doses to cause the same effect

Question 8

What is the MOA of beta-blockers?

Answer 8

beta-1 adrenoreceptor antagonists

completely inhibit beta-1 adrenoreceptors in cardiac tissue preventing binding of agonists like adrenaline and noradrenaline

Question 9

What is the MOA for calcium channel blockers?

Answer 9

CCB crosses membrane and binds to L-type calcium channel

binding to the channel causes a conformational change and this forces the channel to remain inactive

this causes vasodilation by preventing vascular smooth muscle cell contraction

Question 10

What drug has this MOA:

Answer 10

ivabradine