What are the front line drugs in coronary heart disease?
Angiotension system blockers (ACEi and ARBs)
How do beta-blockers aid in the treatment of coronary heart disease?
Block sympathetic input > Reduce HR and contractility > Reduce O2 demand > Reduce ischaemia = Symptomatic control
Reduced SNS driven pathological ventricle remodelling = Long term improvement in mortality
Which beta-blockers are used in coronary heart disease?
What are the side effects of beta-blockers?
When are beta-blockers contraindicated?
Hypoglycaemic diabetics as they might mask hypo's
Hyperglycaemic as they disrupt control
What cohort of patients with CHD should be on statins?
All of them regardless of LDL levels
What are the side effects of statins?
Elevated AST and ALT
Arrange these statins in order of their potency
Why are angiotension system inhibitors used in coronary heart disease?
Prevent their stimulation of pathological ventricular remodelling. Enlarged ventricles are more susceptible to CHD (and HF)
Which ACEi are used for coronary heart disease?
What are the side effects of ACEi?
What angiotension receptor blockers are used in CHD?
What dose of aspirin is used in CHD?
How does clopidogrel work?
Inhibits ADP necessary for platelet activation
When is clopidogrel used?
When aspirin is contraindicated (bleeding risk)
Or on top of aspirin
What major drug drug interaction does clopidogrel have?
With PPIs as they block metabolism of its pro-form
How are nitrates used in CHD? How do they work?
Dilate coronary arteries
What are the side effects of nitrates?
Which Ca channel blockers are sometimes used in CHD?
Dihydropyridines eg amlodipine
- vasodilate: peripheral and coronary
No mortality benefit
What are the side effects of dihydropyridines?
Why don't verapamil and diltiazem provide long term mortality benefit?
They don't prevent pathological remodelling