Clinical Pharmacology of Stable coronary disease Flashcards
(34 cards)
How does angina arise
mismatch between myocardial oxygen supply and myocardial demand
What increases myocardial demand
Heart rate
Preload
Afterload
Myocardial contractility – systolic function
Myocardial relaxation – diastolic function
Myocardial wall stress
How is angina treated
- Relieve symptoms
* Reduce workload
* Improve coronary blood flow - Slow/halt the disease process
- Prevent myocardial infarction
- Prevent premature death
What are the different pharmacotherapy for angina
Rate limiting
Vasodilators
Sodium channel activators
What are the different rate limiting options
Beta-adrenoreceptor antagonist
Calcium channel blocker (L-type)
Ivabradine (f-channel)
What are the different vasodilator options
Nitrates – nitric oxide
Calcium channel blocker
Potassium channel activator
What are the sodium channel activator options
Ranolazine
What are the disease modifying pharmacotherapies
Antiplatelets
Cholesterol lowering
What are the different antiplatelet drugs
Aspirin
Clopidogrel
Ticagrelor
Prasugrel
What are the different cholesterol lowering drugs
HMG-CoA reductase inhibitors
Fibrates
PCSK-9 inhibitors
What is the mechanism of action of beta-adrenoreceptors antagonists
Reversible inhibitor of beta 1 and 2 receptors
Blocks sympathetic system
Selective vs Non-selective
What are the benefits of beta blockers
Heart rate – reduce myocardial workload
Contractility
Systolic wall tension – improve relaxation
Increases diastolic perfusion time
Reduces rate of ischaemic events and mortality
What are the side effects of beta blockers
Asthma
Peripheral vascular disease
Raynaud’s syndrome
Acute heart failure
Bradycardia or heart block
Fatigue
Impotence
What are the selective and non-selective beta blockers
Cardio selective:
* Bisoprolol
* Metoprolol – shorter acting
* Atenolol
Non-selective:
* Carvedilol
* Propranolol
What is the mechanism of action of calcium channel blockers
Prevent calcium influx into myocytes and smooth muscle arteries/arterioles by blocking L-type Ca channel
Dihydropyridine mostly relax smooth muscle
Non-dihydropyridines mostly reduce heart rate
What are the benefits of calcium channel blockers
Heart rate - Exclusively NDHP like Verapamil/Diltiazem
Reduce contractility (NDHP)
Reduce afterload (DHP)
Increases diastolic perfusion time (NDHP)
What are the side effects of calcium channel blockers
Peripheral oedema (DHP)
Bradycardia/heart block (NDHP)
Hypotension (Both)
Reduced LV function
Headache
Flushing
What are the side effects of calcium channel blockers
Peripheral oedema (DHP)
Bradycardia/heart block (NDHP)
Hypotension (Both)
Reduced LV function
Headache
Flushing
What are the dihydropyridine and non-dihydropyridines
Dihydropyridine (DHP)
* Amlodipine
* Felodipine
* Nifedipine
Non-dihydropyridine (N-DHP)
* Verapamil
* Diltiazem
What is the mechanism of action of nitrates
Nitric Oxide mediated smooth muscle relaxation
Non-selective
Long-acting preparations most effective
Sublingual has utility for acute attacks
What are the benefits of nitrates
Reduce preload and afterload – Therefore myocardial workload
Improve coronary flow via vasodilation (Epicardial arteries and improve blood supply)
Doesn’t reduce mortality
What are the side effects of nitrates
Severe aortic stenosis
Hypotension
Headache
What is the mechanism of action of potassium channel activator
Activates ATP sensitive potassium channels
causing potassium influx
Resultant inhibition of Calcium influx:
1. Negative inotrope
2. Smooth muscle relaxation (coronary and peripheral)
What are the side effects of potassium channel activators
Hypotension
GI ulceration
