Cardiovascular Therapeutics

Question 1

What is ischaemic heart disease a consequence of

Answer 1

Atherosclerosis within the coronary artery

Question 2

Which gender has a higher risk of heart disease

Answer 2

Males

Question 3

What is stable angina

Answer 3

Chest pain on exertion which go away at rest

Question 4

What is unstable angina

Answer 4

Plaque rupture and the formation of a non-occlusive thromboembolism or vasospasm

-SYmptoms are there at rest

Question 5

What is coronary artery bypass grafting

Answer 5

Bypassing the blockage

Question 6

What is angioplasty

Answer 6

Advance catheter into coronary circulation and then break open a ‘balloon’ to break open the blockage

Question 7

What is the standard procedure to overcome a heart attack

Answer 7

Angioplasty and place a stent in

Question 8

What is the pharmacological management of angina

Answer 8

Given GTN spray under tongue and acts by the release of nitrous oxide

Question 9

How does GTN act

Answer 9

Releases nitrous oxide which causes venodilatation which leads to a decrease in preload and a reduction in cardiac work

Question 10

If a patient is given oral nitrates, what is the problem

Answer 10

Prolonged exposure can reduce effectiveness

Question 11

How to overcome the reduced nitrate effectiveness caused by oral nitrates

Answer 11

2 doses rather than 3 per day and then add a tablet in substitution for one of the doses

Question 12

Best therapy for angina (FIRST CHOICE DRUGS)

Answer 12

Beta blockers (atenolol)

Question 13

What does atenolol do

Answer 13

Blocks beta 1 adrenoceptors which reduces the force of contraction and slows the heart down

Question 14

When does coronary flow only occur during

Answer 14

Diastole

Question 15

What does atenolol do to coronary Flow

Answer 15

Coronary flow only occurs during diastole so by slowing the heart, the diastolic period will be increased- as will the time for coronary blood flow so coronary blood flow is increased

Question 16

When should atenolol be stopped

Answer 16

When the patient has heart failure as the heart failure will get worse

Question 17

IF the patient develops heart failure, what should you do in regards to drugs

Answer 17

Stop the high dose atenolol and prescribe a really small dose of visoprolol

Question 18

If you can’t prescribe a beta blocker for someone with ischaemic heart disease, what would you prescribe

Answer 18

Calcium channel blocker

Question 19

What are the two classes of calcium channel blockers

Answer 19

Dihydropyridines and verapamil

Question 20

What is verapamil do

Answer 20

Acts on cardiac muscle and reduces Ca2+ entry which reduces force of contraction

-Also has anti-arrhythmic activity

Question 21

What is verapamil a type of

Answer 21

rate limiting agent

Question 22

What do dihydropyridines do

Answer 22

Don’t affect the heart- Only acts on vascular smooth muscle and cause vasodilatation

Question 23

What do rate limiting agents act on

Answer 23

Cardiac muscle

Question 24

Can you use rate limiting agent when the person has heart failure

Answer 24

No as they will worsen the heart failure

Question 25

What is Nicorandil

Answer 25

Vasodilator (potassium channel activator)

Question 26

What does Ivabradine do

Answer 26

Reduces heart rate

Question 27

What other drugs can you use with a person with ischaemic heart disease and why

Answer 27

Antiplatelet drugs as there is an increased risk of platelets sticking to a stenosis

Question 28

What anti platelet drugs are used when a person has ischaemic heart disease

Answer 28

Low dose aspirin | Clopidogrel

Question 29

What are statins

Answer 29

HMG CoA Reductase inhibitors so they inhibit cholesterol synthesis

Question 30

What shouldn't statins be used in conjunction with

Answer 30

Macrolides (antibiotics) Grapefruit juice Calcium channel blockers

Question 31

First course of action if the patient has stable angina

Answer 31

GTN for relief and then assess the cardiovascular risk

Question 32

After assessing the cardiovascular risk, what is the next course of action

Answer 32

- Aspirin or clopidogrel prescription - Statin - Controlling BP - Lifestyle advice ie weight loss and stopping smoking

Question 33

What to do after prescribing aspirin/clopidogrel and also giving lifestyle advice

Answer 33

Preventative measures like giving a beta-blocker and an oral nitrate (or a calcium channel blocker if a beta blocker can't be used)

Question 34

If the beta blocker isn't enough, then what can you prescribe

Answer 34

calcium channel blocker

Question 35

What is the MAJOR CAUTION WHEN prescribing a beta blocker and a calcium channel blocker at the same time

Answer 35

Can't use a rate limiting calcium channel blocker as that is FATAL, so you must ONLY USE A DIHYDROPYRAMIDINE