Angina drugs

Question 1

What conditions does an ACS involve?

Answer 1

Unstable angina.
Non-ST elevation MI.
ST elevation MI.

Question 2

What is the initial treatment for an ACS?

Answer 2

M - morphine.
O - oxygen.
N - nitrates.
A - anti-platelet (aspirin or clopidogrel).

Question 3

What is the preventative treatment for an ACS?

Answer 3

MI-5:
> Aspirin.
> Clopidogrel.
> ACEi.
> Beta blockers.
> Statin.

Question 4

What is the MOA of nitrates?

Answer 4

Release NO > increased cGMP > smooth muscle relaxation.

Question 5

Give some examples of nitrates?

Answer 5

GTN.
Isosorbide mononitrate (long acting).

Question 6

What are the side effects of nitrates?

Answer 6

Headaches.
Hypotension.
Flushing.

Question 7

When are nitrates contra-indicated?

Answer 7

Hypotension.
Mitral & aortic stenosis.
Hypertrophic cardiomyopathy.

Question 8

Give examples of anti-platelet drugs?

Answer 8

Aspirin.
Clopidogrel.
Prasugrel.
Ticagrelor.

Question 9

What is the MOA of aspirin?

Answer 9

Irreversibly inhibits COX > inhibition of TXA2.

Question 10

What are the side effects of aspirin?

Answer 10

GI irritation.

Bronchospasms.

Question 11

When is aspirin contra-indicated?

Answer 11

PUD & bleeding disorders.

Question 12

What is the MOA of clopidogrel?

Answer 12

Pro-drug converted to an active drug by P450 enzymes.

Blocks P2Y12 adenosine receptors on platelets > inhibits aggregation.

Question 13

What are the side effects of clopidogrel?

Answer 13

GI irritation.

Question 14

What are the contra-indications for clopidogrel?

Answer 14

Active bleeding.

Question 15

What interactions does clopidogrel have?

Answer 15

Enzyme inducers (i.e. omeperazole) reduce anti-platelet activity.
Fluoxetine reduces anti-platelet effect.

Question 16

Give examples of ACEi?

Answer 16

Ramipril.

Captopril (short acting).

Question 17

What are the MOA of ACEi?

Answer 17

Inhibits ACE (converts angiotensin I > angiotensin II).

Question 18

What are the side effects of ACEi?

Answer 18

Dry cough.
Hypotension.
Hyperkalaemia.
Renal & hepatic impairment.

Question 19

What do ACEi interact with?

Answer 19

ACEi + diuretics > rapid hypotension.

Question 20

Give examples of angiotensin II receptor blockers?

Answer 20

Losartan.

Question 21

When would you give an angiotensin II receptor blockers?

Answer 21

If patients can not tolerate ACEi due to dry cough.

Question 22

Give examples of beta blockers?

Answer 22

Bisoprolol (B1 anatagonist).

Metoprolol (short acting).

Question 23

What is the MOA of beta blockers?

Answer 23

Beta adrenergic antagonist > decreased HR & contractility.

Question 24

What are the side effects of beta blockers?

Answer 24

Bronchospasm.
Bradycardia.
Cold extremities.

Question 25

What are the interactions of beta blockers?

Answer 25

Risk of AV block if used with diltiazem/verapamil.

Question 26

Give examples of statins?

Answer 26

Simvastatin.

Question 27

What is the MOA of statins?

Answer 27

Inhibit HMG CoA reductase > decreased LDL.

Question 28

What are the side effects of statins?

Answer 28

Altered liver function. Myalgia. Rhabdomyolysis.

Question 29

What interacts with statins?

Answer 29

Grapefruit juice.

Question 30

Give examples of dihydropyridines?

Answer 30

Amlodipine. | Nifedipine.

Question 31

What is the MOA of dihydropyridines?

Answer 31

Inhibits Ca2+ influx > smooth muscle relaxation.

Question 32

What are the contra-indications of dihydropyridines?

Answer 32

Uncontrolled heart failure. Within 1 month of a MI. Aortic stenosis.

Question 33

Gives examples of non-dihydropyridines?

Answer 33

Verapamil. | Diltiazem.

Question 34

What is the MOA of non-dihydropyridines?

Answer 34

Inhibit Ca2+ influx > smooth muscle relaxation. | Slows conduction rate at the AV node.

Question 35

What are the side effects of non-dihydropyridines?

Answer 35

Bradycardia. | SA/AV block.

Question 36

When are non-dihydropyridines contra-indicated?

Answer 36

Bradycardia. | Heart block.

Question 37

Give an example of a K+ channel activator?

Answer 37

Nicorandil.

Question 38

What is the MOA of nicorandil?

Answer 38

NO donor > increased cGMP > smooth muscle relaxation. | Open K+ channels > hyperpolarisation > inhibition of voltage gated Ca2+ channels > smooth muscle relaxation.

Question 39

When is ivabridine used?

Answer 39

As a 3rd line treatment or if beta blockers are contra-indicated.

Question 40

What is the MOA of ivabridine?

Answer 40

Blocks Na+ funny channels > decreased rate of SA firing.

Question 41

When is the use of nicorandil contra-indicated?

Answer 41

LV failure.

Question 42

What are the side effects of ivabridine?

Answer 42

Visual disturbances. 1st degree heart block. Bradycardia.

Question 43

When is the use of ivabridine contra-indicated?

Answer 43

Bradycardia. Acute MI/CVA. 2nd/3rd degree heart block. Unstable/acute CCF.

Question 44

When is ranolazine used?

Answer 44

Cardiologists only - to treat patients who remain symptomatic despite optimal treatment.

Question 45

What is the MOA of ranolazine?

Answer 45

Inhibit late Na+ channels > decreased Ca2+ overload > smooth muscle relaxation.

Question 46

When is the use of ranolazine contra-indicated?

Answer 46

Hepatic impairment. CCF & QT elongation. Elderly & low body weight - < 60kg.