Treatment of stable angina

Question 1

For relief of symptoms

Answer 1

• Beta blockers
• Calcium channel blockers
• Nitrovasodilators
• Ivabridine
• Nicorandil

Question 2

How do Beta blockers work?

Answer 2

• Reduce Heart rate
• Reduce contractility
• Reduce systolic BP
• Increase perfusion to sub endothelium and therefore diastolic blood perfusion
• Protect myocytes from 02 free radicals

Therefore increase the threshold for angina

Question 3

What is rebound phenomena?

Answer 3

When HR is decreased too quickly due to drugs being administered too quickly

• men over 50
• patients with angina

Question 4

ADRs for beta blockers

Answer 4

• bradycardia
• impotence
• fatigue
• bronchospasm

Question 5

Contraindications for beta blockers?

Answer 5

• asthma
• PVD
• Heart failure
• Bradycardia

Question 6

main beta blocker?

Answer 6

Atenolol

Question 7

drug-drug interactions for beta blockers?

Answer 7

primary pharmacodynamic:
-hypotension when used with other hypotensive drugs
-bradycardia when used with other rate limiting drugs
-cardiac failure when used with inotropic drugs
Can mask the effect of hypoglycaemic drugs such as insulin

Question 8

How do calcium channel blockers work?

Answer 8

Block the L-type calcium channels
This prevents influx of calcium and therefore decrease contractility
Rate limiting: decrease HR
vasodilating

Question 9

What are the ADRs for CCBs

Answer 9

• ankle oedema
• flushing
• headache
• palpitations

Question 10

Contraindications for CCBs

Answer 10

• MI
• Bradycardia
• Never use immediate release-NIFEDIPINE

Question 11

how do Nitrovasodilators work?

Answer 11

They release NO- triggers release of cGMP
This cause smooth muscle to dilate and therefore lead to relaxation
Reduces after load and preload which decreases 02 demand
Reduce afterload- arteriolar dilation
Reduces preload- reduces venous return by causing peripheral venodilation
Redistributes blood flow to ischaemic areas

Question 12

ADRs for nitrovasodilators

Answer 12

• hypotension

- headaches

Question 13

Different types of nitrovasodilators

Answer 13

long-acting
short-acting
-GTN spray: sublingual to avoid first-pass metabolism
-Oral nitrates: given once a day- prophylactic
-IV nitrates

Question 14

How Does Ivabridine work?

Answer 14

A selective L-type calcium channel inhibitor

Slows down HR and Sinoatrial node of depolarisation

Question 15

How does Nicorandil work?

Answer 15

• Preconditioning agent
• Activates ATP sensitive K+ channels: K+ efflux and hyper polarisation of smooth muscle of heart wall
• Leads to closure of Ca 2+ channels - Relaxation of smooth muscle and vasodilation of arterioles

Has a negative inotrophic effect so decreases contractility

Question 16

Drugs which slow down progression of disease?

Answer 16

• ACE inhibitors
• statins
• asprin

Question 17

Aspirin/clopidogrel

Answer 17

75-100mg
protect lining of endothelium
Reduce platelet thromboxane production
most common cause of GI bleeds

Question 18

ACE inhibitors

Answer 18

Reduce platelet rupture and stabilise atheromas

Question 19

statins

Answer 19

reduce the deposition of LDLs into atheromas

Question 20

Treatment plan

Answer 20

• beta blockers
• rate limiting CCBs
• vasodilating CCBs
• ivabradine
• aspirin
• statins
• nitrovasodilators
• nicorandil

Question 21

Ranolazine

Answer 21

• prevents late inward flow of sodium into the heart muscle
• this reduces calcium influx
• reduces contractility- reduced o2 requirements