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Cardiovascular > Ischaemic Heart Disease Drugs > Flashcards

Ischaemic Heart Disease Drugs Flashcards

1
Q

describe angina pain

A

heavy, retrosternal chest tightness, LHS, radiates to left side and jaw

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2
Q

what is angina pain associated with

A

breathlessness

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3
Q

what are the co-morbidities of angina

A

diabetes mellitus (as get neuropathy that masks symptoms), previous MI, COPD

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4
Q

what is GTN

A

glyceryl trinitrate, a form of nitrate

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5
Q

what is GTN available as and what is a side effect

A

tablets and sprays (sublingual), patches

fainting, headaches and tolerance

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6
Q

what drugs can be used to treat angina

A

beta blockers, calcium channel blockers, potassium ATP channel activators, long acting nitrates, ivabradine, ranolazine

statins, aspirin, ACE inhibitors

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7
Q

how does GTN help angina

A

acts as venodilator, minor coronary vasodilating effect

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8
Q

how do nitrates help angina

A

nitric oxide donors, act directly on the vascular smooth muscle to produce venous and arterial dilatation,
reducing pre-load, after-load and oxygen demand.

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9
Q

how do beta blockers help angina

A

improve oxygen supply and demand balance by reducing heart rate and blood
pressure, decreasing end systolic stress and contractility and prolonging diastole, allowing more
coronary flow. Act on beta 1 adrenoceptors in heart which mediate inotropic effects and chronotropic effects.

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10
Q

how do calcium channel blockers help angina

A

inhibit calcium transport and induce smooth muscle relaxation.

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11
Q

what drugs increases vagal tone

A

digoxin

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12
Q

how does ivabrodine help angina

A

reduces heart rate by inhibitor funny current channels

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13
Q

give an example of a non selective beta blocker

A

propanolol

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14
Q

give an example of a B1 selective beta blocker

A

atenolol, bisoprolol

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15
Q

name two calcium channel blockers

A

Verapamil, diltiazem

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16
Q

what are the side effects of calcium channel blockers

A

ankle oedema, arrhythmias (bradycardia and heart block)

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17
Q

what is dihydropyridine

A

vasodilating calcium channel blocker

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18
Q

what type of patients benefit from ivabrodine

A

those who aren’t cured/ cant use beta blockers (asthmatics)

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19
Q

what causes stable angina to become unstable

A

rupture of plaque in coronary artery

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20
Q

what is nicorandil

A

vasodilatory drug used to treat angina, causes severe ulcers as SE

21
Q

what is ranolazine

A

drugs which acts metabolically to reduce the workload of the heart, used in angina (late sodium channel mediator)

22
Q

what can an ST depression suggest

A

myocardial ischaemia

23
Q

in what lead should the R wave be tallest

A

lead 2

24
Q

what does a tallest r wave in lead 1 mean

A

deviated to the left axis

25
Q

what does a tallest r wave in lead 3 mean

A

right axis deviation

26
Q

describe ST elevation in MI

A

(STEMI) in V1-4, anteroseptal ST elevation (tombstoning elevation)

27
Q

what is troponin

A

protein released into bloodstream during heart attack, indicate damage to the myocardium

28
Q

what does persistent ST elevation suggest when associated with heart pain

A

STEMI

29
Q

what does ST abnormalities with normal troponin and heart pain mean

A

unstable angina

30
Q

what does a normal ECG with rise/fall in troponin and chest pain suggest

A

NSTEMI

31
Q

what is used to treat a NSTEMI

A

(keep blood very thin)

aspirin, pain relief, O2, clopidogrel, fondaparinux, beta blocker, IV GTN, Glycoprotein IIB/IIIA inhibitor

32
Q

how does aspirin help in a NSTEMI

A

inhibits thromboxane (antiplatelets)(cox1 inhibitor)

33
Q

what is the side effect of aspirin

A

GI bleeding

34
Q

what is the conservative approach to treating NSTEMI

A

asymptomatic patients are given several days for plaque to stabilise, exercise testing performed, catherterised if symptoms persist

35
Q

describe the early invasive approach to NSTEMI

A

intensive medical regime with more widespread use of clopidogrel and IIB/IIIA

prompt catheteristion with subsequent revascularisation

36
Q

what is intermittent claudication

A

cramping in legs when exercise caused by atherosclerosis in peripheral arteries

37
Q

what effect do beta blockers have on intermittent claudication

A

can worsen it as blocks dilation of vessels in skeletal muscles during exercise

38
Q

what drugs could be used to treat intermittent claudication if nitrates causing headaches

A

calcium channel blocker or ivabradine

39
Q

what is a side effect of amoldipine

A

ankle oedema

40
Q

what drug can replace amoldipine if that causes ankle oedema

A

nicorandil

41
Q

what other symptoms does heart failure lead to

A

fatigue, SOB (congestion of the lungs), retention of fluid- peripheral oedema

42
Q

what treatments should be given to someone in heart failure

A

digoxin, anticoagulants, ACE inhibitor, spironolactone, nitrates, aspirin

43
Q

how does digoxin help heart failure

A

slows and strengthens heart contractions

44
Q

how does spironolactone

A

prevents fluid retention

45
Q

how does the body respond to the heart beating poorly and how is this resolved

A

releases catecholamines, hormones which activates symp system and RAAS, rising BP

stopped by Beta blockers, ACE inhibitors and ARBs (blood pressure)

46
Q

why are anticoagulants required in atrial fibrillation

A

blood clots usually in left atrial appendage which can lead to stroke

47
Q

Shortly after he is commenced on ACE inhibition his plasma creatinine concentration doubles, why?

A

Ace can worsen renal function

48
Q

how can diuretics help heart failure

A

help get rid of unnecessary water and salt via urination

49
Q

what diuretics are used to treat heart failure

A

spironolactone, furosemide etc

Cardiovascular (34 decks)

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