Angina

Question 1

What is stable angina?

Answer 1

Chest Pain that comes on predictably on exertion and dissipates at rest

Question 2

What are the big 5 CVD risks?

Answer 2

Smoking
High BP
FH
Cholesterol 
Diabetes

Question 3

What are the the therapeutic objectives for Angina?

Answer 3

Amelioration of anginal symptoms and improved angina-free exertion capacity

Prevention of subsequent acute MI

Question 4

How can the work the heart has to do, be relieved?

Answer 4

Reduce -
Pre-load
Afterload 
Contractility 
Heart rate

Question 5

What drug classes are used in the treatment of angina?

Answer 5

Nitrates
Calcium Channel Blockers
Beta Blockers

Question 6

What do Beta Blockers reduce?

Answer 6

Contractility and Rate majorly

Preload and Afterload are affected to a lesser degree via the renin-angiotensin system by reducing angiotensin II and thus vasoconstriction

Question 7

Where to beta blockers work?

Answer 7

Block beta 1 receptors in the heart

Question 8

What does vasoconstriction reduce?

Answer 8

Increases Afterload

Question 9

What do CCB’s do?

Answer 9

Block L-type calcium channels

Question 10

What are the two types pf CCB?

Answer 10

dihydropyridine - more effective on vessels impact BP greatly

non-dihydropyridine - more effective on heart

Question 11

Which type pf CCB is more useful in treating angina?

Answer 11

Non-dihydropyridine

Question 12

How doe nitrates work?

Answer 12

Atherosclerotic vessels’ endotheilum does not produce NO

Nitrates will dilates coronary vessels

Reducing afterload and preload

Both arterial and venous systems are dilated

Question 13

What is used in the short-term treatment on angina?

Answer 13

GTN manages acute attacks

Also used for prophylaxis

Question 14

What is used in the long-term treatment on angina?

Answer 14

Beta Blockers

Question 15

Why is GTN preferred for acute attacks?

Answer 15

Sublingual administration allows for faster drug delivery

Betablockers are all oral tablets

Question 16

What are the cautions for when using GTN?

Answer 16

Tolerance

Can be reduced by leaving gaps between doses

Question 17

What is the mechanism behind the development of tolerance?

Answer 17

Vascular tolerance
Impaired GTN biotransformation
Increased vascular superoxide production
Desensitisation of soluble guanylate cyclase
Increases in phoshopdiesterase activity
Increases sensitivity to vasoconstrictors
Increased endothelin expression

Question 18

What are the three most commonly prescribed beta blockers in this area?

Answer 18

Bisprolol
Atenolol
Propranolol

Question 19

What are the adults does for the three beta blockers?

Answer 19

Bisoprolol - 5–10 mg once daily; maximum 20 mg per day.

Atenolol –.100mg daily in 1-2 divided doses.

Propranolol - Initially 40 mg 2–3 times a day; maintenance 120–240 mg daily

Question 20

What are the differences in dosing strategy for bisprolol for angina and heart failure?

Answer 20

Angina is 5-20mg but the LOWEST dose that works - resolving a symptom and tying to reduce morbidity

Heart Failure is 1.25-10mg at the HIGHEST dose the patient can tolerate since in heart failure you aren’t treating a symptoms but trying to reduce mortality

Question 21

What age related changes decrease drug effectiveness?

Answer 21

Decreased GI blood flow
Decreased plasma proteins
Decreased cardiac beta-adrenoreceptors

Question 22

What age related changes increase drug effectiveness?

Answer 22

Decreased liver enzymes

Decreased renal blood flow