CAD/Angina

Question 1

Define organic nitrates and list examples

Answer 1

Organic nitrates are converted into nitric oxide in VSMCs which causes the blood vessels to relax and induce vasodilation
eg: Glyceryl Trinitrate (Nitroglycerin), Isosorbide Mononitrate

Question 2

Define beta-blockers and list examples

Answer 2

It prevents adrenaline and noradrenaline from binding onto beta-adrenoreceptors in the heart which reduces heart rate and contractile force
eg: Atenolol, Bisoprolol, Carvedilol, Metoprolol

Question 3

Define calcium channel blockers and list examples

Answer 3

It blocks calcium channels and decrease entry of calcium ions which causes blood vessels to relax
eg: Diltiazem, Verapamil, Amlodipine, Felodipine, Nicardipine

Question 4

Define HCN4 channel blocker and list an example

Answer 4

Block HCN4 channels and decrease the formation of the pacemaker current in the SA node of the heart
eg: Ivabradine

Question 5

List the contraindications of nitrates

Answer 5

1) Low systolic blood pressure (<95mmHg)
2) Increased Intracranial pressure
3) Patients on Phosphodiesterase Inhibitors Type 5 (PDE5): Due to causing extreme hypotension

Question 6

List the contraindications of beta-blockers

Answer 6

1) Asthma
2) Diabetes
3) Patients on Calcium Channel Blockers = AV Heart Block

Question 7

List the contraindications of calcium channel blockers

Answer 7

1) Patients with heart failure: Due to decreasing the force of contraction of the heart
2) Patients on B-blockers: Due to increasing the risk of AV heart block

Question 8

List the contraindications of HCN4 ion channel blocker

Answer 8

1) Sick Sinus Syndrome: Due to sinus node defects
2) Patients on Calcium Channel Blockers = AV Heart Block
3) Patients on CYP3A4 inhibitors, Azole Antifungals (Ketoconazole), Macrolide Antibiotics, Antiretrovirals (Nelfinavir, Ritonavir)

Question 9

List the side effects of nitrates

Answer 9

1) Develop Tolerance [Solution: Use low doses and stop treatment for 8-12 hours daily at night when the patient is usually inactive]
2) Orthostatic Hypotension when standing.
3) Reflex Tachycardia: Due to Carotid Sinus and Aortic arch baroreceptors detecting a decrease in blood pressure
4) Dizziness → syncope
5) Migraine-Like Headaches

Question 10

List the side effects of beta-blockers

Answer 10

1) Hypotension → Dizziness and syncope
2) Bradycardia (<60 bpm)
3) AV Heart Block
4) Fatigue
5) Bronchoconstriction
6) Hypoglycemia
7) Cold Extremities
8) Impotence

Question 11

List the side effects of calcium channel blockers

Answer 11

1) Hypotension → Dizziness
2) Reflex Tachycardia
3) Headache
4) Flushing
5) Constipation
6) Peripheral Oedema

Question 12

List the side effects of HCN4 ion channel blocker

Answer 12

1) Luminous Phenomena (Enhanced Vision Brightness)
2) Blurred vision
3) Bradycardia (<60 bpm)
4) AV Heart Block
5) Hypotension
6) Fatigue
7) Dizziness
8) Headaches