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Antianginal Flashcards

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1
Q

Principles of treatment of CCS

A

Use of antiischemic or antianginal agents and prevention of adverse cardiovascular event

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2
Q

No donors

A

Glyceril trinitrate,isosorbide mononitrate

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3
Q

1st gen beta Andre preceptor antagonist

A

Propranalol

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4
Q

Non dihydropiridine calcium channel blockers

A

Verapamil, diltiazem

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5
Q

Late Na flow inhibitor

A

Ranolazine

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6
Q

Sinoatrial node inhibitor

A

Ivabradine

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7
Q

Hypolipidemic agents are

A

Atorvastatin,fenofibrate,ezetimibs,evolozumab

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8
Q

Drugs used for prevention of adverse cardiovascular event

A

Hypolipidemic agents,RAAS, antiplatelet,ACE inhibitor,ARB

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9
Q

Cause of angina

A

Disrupted balance of oxygen supply and consumption

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10
Q

To reduce angina

A

Reduce oxygen consumption or increase oxygen supply

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11
Q

Oxygen demand increases when

A

Increase in HR, Contractions,wall tension, Preload ,afterload

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12
Q

Decrease oxygen supply due to

A

Decreased vessel caliber,perfusion pressure and increased HR, ventricular wall tension

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13
Q

Oxygen consumption can be reduced through

A

Reduced preload, afterload and CMV

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14
Q

Increased oxygen supply can be done through

A

Coronary blood vessel dilation, negative chronotropy

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15
Q

Negative chronotropy gives

A

Prolonged diastolic filling,so more oxygen supply

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16
Q

Nitrates and dihydropiridine calcium channel blockers cause

A

Reflex tachycardia

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17
Q

NO donors cause

A

Venodilation, arterial dilation and coronary arterial dilation,so hypotensive and antianginal effect

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18
Q

Glyceril trinitrate,fast and short acting

A

1-3min start, duration 20-30min, sublingual,first pass effect, antianginal

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19
Q

Side effects of glyceril nitrate

A

Headache, hypotension,reflex tachycardia

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20
Q

ISMN,Long acting,6-8 hr

A

Prevention of angina attack, interactions with pde5inhibitors cause life threatening hypotensive reaction

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21
Q

Dihydropiridine drugs are

A

Vasoselective calcium channel blockers -vasodilation

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22
Q

Dihydropiridine drugs acts on peripheral arteries and

A

Coronary arteries,cause dilation and antianginal and hypotensive effect

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23
Q

Side effects of dihydropiridine calcium channel blockers

A

Headache,facial flushing, fatigue, peripheral edema, constipation

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24
Q

Vasospastic anginais same as

A

Princmetals angina

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25
Clinical use of dihydropiridine drugs
Prevention or prophylaxis of angina attack and prevention of vasospastic angina attack
26
Non dihydropiridine calcium channel blockers are
Cardiodepressent and are non selective
27
Clinical use of both calcium rare same
Prevention of angina attack and vasospastic angina attack
28
Action of non dihydropiridine blockers
Reduce CMV, peripheral arterial dilation,coronary artery dilation,diastole prolongation and reduce AV conduction
29
CCB acts on
L type voltage dependent calcium ion channels
30
Undamaged endothelium releasing NO and PGI2
Inhibits platelets activation
31
CCB s are
Metabolic poison , because it increases dependence on carbohydrate metabolism than FFA
32
CcBs cause
Coronary and peripheral vasodilation, decrease heart contractility,,slowed AV nodal conduction and depressed SA node activity
33
Beta blockers and verapamil interactions cause
Bradyarrythmia and if used parentaral asystole
34
Inhibitors of cyp450
Macrolide antibiotics and grapefruit juice
35
CCB intoxication cause
Hypotension and bradycardia and prolonged PR i,nausea, vomiting, metabolic acidosis and hyperglycaemia
36
Dihydropiridine cause
Vasodilatory shock
37
Verapamil and diltiazem cause
Vasodilatory and cardiogenic shock+bradycardia
38
Bradycardia can be caused by
Sinus bradycardia, second or 3rd degree AV block or sinus arrest
39
CCB doesn't affect
QRS duration
40
CCB toxicity can be treated by
Calcium chloride or calcium gluconate for cardiac contraction, insulin against hyperglycaemia, Epinephrine, dobutamine or isoproterenol against cardiogenic shock and phenylephrine and norepinephrine against vasodilatory shock
41
HIET
High dose insulin euglycemic therapy
42
BAB are
Cardiodepressent
43
BAB action
Reduce CMV, prolonged diastole, reduce AV conduction
44
Use of BAB
Prevention of angina attack
45
Side effects of BAB
Bradycardia,AV block, bronchospasm, cold extremities
46
NO modulators have reflex increase in
HR and contractility
47
End diastolic volume and ejection fractions increase for
BAB and CCB
48
Ivabradin
Inhibits na ion flow in 4th phase of AP in SA node
49
Action of ivabradin
Dose dependent decrease of HR, prolonged diastole
50
Use of ivabradin
In prevention or prophylaxis of stable angina attack
51
Side effects of ivabradin (SA node inhibitor
Photopsy(light phenomenon in the retina, bradycardia
52
Ranolazine
Cause late blockade of na channels
53
Ranolazine action
Indirectly reduces intracellular calcium ion concentration and therefore reduce myocardial diastolic tension,so decrease oxygen consumption,improves perfusion
54
Atorvastatin action
g co A reductase inhibition +pleiotropic effects (plaque stabilization,,blocks synthesis of mevalonic acid in the liver, increase LDL receptor in liver and decrease LDL in plasma
55
Atorvastatin
hMG co A reductase inhibition +pleiotropic effects (plaque stabilization,,blocks synthesis of mevalonic acid in the liver, increase LDL receptor in liver and decrease LDL in plasma
56
Atorvastatin uses
Dyslipidemia, prevention of cardiovascular events
57
Side effects of atorvastatin
Hepatic function impairment (hepatopathy )and myopathy
58
Fibric acid derivatives
Fenofibrate
59
PPAR alpha agonist
Fenofibrate
60
Action of Fenofibrate
Activation of PPAR alpha leads to LPL gene expression ,lead serum LPL activation,lead to lipolysis, decrease TG and increase LDL receptor in liver
61
Cholesterol absorption inhibitor
Ezetimibe
62
Ezetimibe Acton
Blocks transport protein NPC1L1 in enterocyte villi-decrease cholesterol absorption (doesn't affect fat sol but,TG or bile acids)-decrease LDL
63
PCSK9 inhibitor
Evolozumab
64
Evolozumab action
Inhibition of LDL receptor degrading enzymes
65
Evolozumab action
Human IgG2 binds with PCS K9 affecting PCSK9 mediated degrading of LDL receptor in liver -decrease LDL naturally
66
PCSK9
Proprotein convertase subtilisin/kexin type 9
67
Vasospastic angina can be treated by
CCB and long acting organic nitrates
68
Treatment of structural microvascular angia
BAB,ACE,statins
69
Microvascular functional changes(vasospastic form treatment
Calcium CB,Long lasting organic nitrate

Antianginal (1 decks)

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