Clinical Pharmacology of Stable Coronary Heart Disease and Angina

Question 1

What is silent ischaemia?

Answer 1

No pain

Question 2

Who is often effected by this?

Answer 2

Diabetics

Question 3

What are the risk factors of stable angina?

Answer 3

• Hypertensive
• Male
• Hyperlipidaemia
• Hyperglycaemia
• Male
• Post-menopausal female

Question 4

What is hyperlipidaemia a disease of?

Answer 4

Muscular arteries —coronary

cerbral

Question 5

What is a fatty streaks?

Answer 5

Subendothelial accumulation of large foam cells (derived from macrophages plus SM cells) Filled with lipid

Question 6

What a fibrous plaque?

Answer 6

• More advanced and the cause of disease
• Develop from fatty streaks
• Projects into arterial lumen
• Reduced blood flow

Question 7

Where are the changes taking place when an artery becomes atherscerlosed?

Answer 7

intimal layer

Question 8

What accumulates in an atheroma?

Answer 8

Monocytes, lymphocytes, foam cells and connective tissue

Question 9

What is the origin of of the foam cells?

Answer 9

Mostly muscle origin

Question 10

What is SCAD?

Answer 10

Stable coronary artery disease

Question 11

Why does SCAD arise?

Answer 11

mismatch between myocardial blood/oxygen supply and demand

Question 12

What is demand ischaemia?

Answer 12

Ischaemia during stress

Question 13

What determines demand?

Answer 13

• Heart rate
• Systolic blood pressure
• Myocardial wall stress
• Myocardial contractility

Question 14

What is supply ischaemia?

Answer 14

Ischaemia at rest

Question 15

Determinants of supply?

Answer 15

• Coronary artery diameter and tone
• Collateral blood flow
• Perfusion
• Heart rate

Question 16

How do drugs decrease myocardial oxygen demand?

Answer 16

Reducing cardiac workload

• Reduce heart rate
• Reduce myocardial contractility
• Reduce afterload

Question 17

Name the rate limiting drugs for SCAD?

Answer 17

• Beta-adrenoceptor antagonists
• Ivabradine
• Calcium channel blockers

Question 18

Name the vasodilations used to teat SCAD

Answer 18

Calciumchannel blockers

Nirates

Question 19

What do beta blockers act on?

Answer 19

• Heart rate
• Contractility
• Systolic

Question 20

What do beta blockers do to subendocardium?

Answer 20

Allows improved perfusion by increasing diastolic perfusion time

Question 21

name 2 beta blockers?

Answer 21

• Bisoprolol

- atenolol

Question 22

What are beta blockers?

Answer 22

They are reversible anatgonists of the B1 and B2 receptors

Question 23

What do beta blockers do?

Answer 23

• decrease the heart rate
• Decrease contracility
• Decrease CO
• Decrease BP
• Protect cardiomyocytes from oxygen free radicals formed during ischaemic episodes

Question 24

What is rebound phenomena?

Answer 24

-Sudden cessation of beta blocker therapy may precipitate myocardial infarction

Question 25

What are the contradictory conditions to prescribing beta blockers?

Answer 25

- Asthma - peripheral vascular disease - Raynauds syndrome - Heart failure (on sympathetic drive) - Bradycardia/Heart block-over do

Question 26

What is raynauds syndrome?

Answer 26

smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas (vasospasm).

Question 27

What are the adverse drug reactions of beta blockers?

Answer 27

- Tiredness/fatigue - Lethargy - Impotence - Bradycardia - Bronchospasm

Question 28

What can happen when beta blockers are given with other rate limiting drugs ]?

Answer 28

Bradycardia

Question 29

Name two rate limiting drugs?

Answer 29

- verapamil | - diltiazem

Question 30

When can beta blockers cause cardiac faiure?

Answer 30

When used with negatively ionotropic agents

Question 31

What can beta blockers mask?

Answer 31

hypoglycaemic actions of insulin or oral hypoglycaemics

Question 32

Name 3 calcium channel blockers?

Answer 32

Diltiazem Verapamil Amlopidpine

Question 33

how do CCB`s work?

Answer 33

Prevent clacium influx into myocytes and smooth muscle lining arteries and arterioles by blocking the L-type calcium channel

Question 34

What are the two types of calcium blockers?

Answer 34

- Rate limiting (dilitazem verapamil) | - Vasodilating (nifedipine or amlodipine)

Question 35

What can cause MI strokes if given rapidly?

Answer 35

Nifedipine immediate release

Question 36

What are some adverse drug reactions to CCB`s?

Answer 36

- Ankle oedema - headache - Flushing - Palpitaion

Question 37

Name 3 nitrovasodilators?

Answer 37

- Glyceryl trinitrate - Isosrbide mononitrate - Isosorbide dinitrate

Question 38

How can you administer GTN?

Answer 38

- Sublingual - Buccal - Transdermal

Question 39

How can you administer isosorbide mono/dinitrate?

Answer 39

-Sustained release formulation,tablets

Question 40

What can GTN cause?

Answer 40

Syncope

Question 41

How do nitrovasodilators relax muscle?

Answer 41

by releasing NO which then stimulates the release of cGMP which produces smooth muscle relaxation

Question 42

How do nitrovasodilators reduce myocardial oxygen consumption?

Answer 42

Reduce preload and after load

Question 43

How do nitrates relieve angina?

Answer 43

- Arteriolar dilation - Venodilation (less preload less work) - Revlieving coronary vasospasm - Redistributing myocardial blood flow to ischaemic areas of the myocardium

Question 44

Do nitrates reduce morbidity?

Answer 44

NO evidence of this

Question 45

What adverse drug reactions to nitrates?

Answer 45

- Headache | - Hypotension

Question 46

Name one potassium channel opener?

Answer 46

Nicorandil

Question 47

How do potassium channel openers work?

Answer 47

- Activate "silent" potassium channels | - Then entry of potassium into cardiac myocytes inhibits the calcium influx and so has a negative inotropic action

Question 48

What level of treatment is potassium channel openers and why?

Answer 48

- Third line | - Bowel ulceration

Question 49

What does Ivabradine do?

Answer 49

Is a selctive sinus node If channel inhibitor - Slows the diastolic depolarisation slope of the SA-node - Reduces heart rate and therefore O2 demand

Question 50

Name an antiplatelet agent

Answer 50

-Low does aspirin

Question 51

How does aspirin work?

Answer 51

inhibits platelet thromboxane production

Question 52

What does thromboxane do?

Answer 52

Stimulate platelet aggregation and vasoconstriction

Question 53

What is the most common cause of admission with a GI bleed

Answer 53

Low dose aspirin

Question 54

When should aspirin be given?

Answer 54

When HR is greater then 70 bpm

Question 55

How does clopidogrel work?

Answer 55

Inhibits ADP receptor activated platelet aggreagtion

Question 56

Name 3 cholesterol lowering agents?

Answer 56

Simvastatin Pravastatin Atorvastatin

Question 57

What do cholesterol lowering drug inhibit?

Answer 57

HMG coA reductase

Question 58

What is the regime in order for treating SCAD?

Answer 58

-Beta blockers -rate limiting CCB -Dihydropiridine CCB -Ivabradine -Aspirin -Statin -Nitrate Refer refer refer