SIHD and Angina Therapy

Question 1

Risk factors of ischaemic heart disease

Answer 1

Hypertension
Smoking
Hyperlipidaemia
Hyperglycaemia
Male
Post-menopausal females

Question 2

Attacks of angina precipitated by

Answer 2

Any stress which increases heart rate, stroke volume or blood pressure

Question 3

Determinants of oxygen demand

Answer 3

Heart rate
Systolic blood pressure
Myocardial wall stress
Myocardial contractility

Question 4

Determinants of supply

Answer 4

Coronary artery diameter and tone
Collateral blood flow
Perfusion pressire
Heart rate (duration of diastole)

Question 5

Demand ischaemia

Answer 5

During stress

Question 6

Supply ischaemia

Answer 6

At rest

Question 7

Drugs correct supply/demand imbalance by

Answer 7

Decreasing oxygen demand and increasing oxygen supply

Question 8

Ischaemic heart disease caused by

Answer 8

Imbalance of oxygen supply/demand

Question 9

Drugs decrease oxygen demand by

Answer 9

Reducing heart rate, myocardial contractility and afterload

Question 10

Rate limiting drugs

Answer 10

Beta blockers
Ivabradine
Calcium channel blockers

Question 11

Vasodilator drugs

Answer 11

Calcium channel blockers

Nitrates

Question 12

Potassium channel opener

Answer 12

Nicorandil

Question 13

Anti-ischaemic drug for alleviating stable angina symptoms

Answer 13

Ranolazine

Question 14

Anti-platelet drugs

Answer 14

Aspirin
Clopidogrel
Tigagrelor

Question 15

Cholesterol lowering agents

Answer 15

Fibrates

Question 16

Examples of beta blockers

Answer 16

Bisoprolol

Atenolol

Question 17

Function of beta blockers

Answer 17

Block sympathetic system by blocking beta 1 and 2 receptors

Question 18

Contraindications of beta blockers

Answer 18

Asthma
Peripheral vascular disease
Raynauds syndrome
Heart failure
Bradycardia/heart block

Question 19

Effect of beta blockers

Answer 19

Increase diastolic perfusion time
Decrease heart rate, contractility and blood pressure
Increase exercise threshold

Question 20

Adverse drugs reactions of beta blockers

Answer 20

Tiredness/fatigue
Lethargy
Impotence
Bradycardia
Bronchospasm
Rebound phenomena

Question 21

Drug-drug interactions of beta blockers

Answer 21

Hypotension when used with hypotensives
Bradycardia when used with other rate limiting drugs
Cardiac failure when used with negatively inotropic agent
NSAIDS antagonise antihypertensive actions
Exaggerate hypoglycaemic actions of insulin

Question 22

Examples of calcium channel blockers with types

Answer 22

Diltiazem - rate limiting
Verapamil - rate limiting
Amlodipine - vasodilator

Question 23

Function of calcium channel blockers

Answer 23

Block L-type calcium channels to prevent calcium influx into myocytes and smooth muscle lining arteries and arterioles

Question 24

Effect of rate limiting calcium channel blockers

Answer 24

Reduce heart rate and myocardial contractility

Question 25

Effect of vasodilating calcium channel blockers

Answer 25

Reduce vascular tone, produce vasodilation and reduce afterload

Question 26

Contraindications of calcium channel blockers

Answer 26

Post MI | Unstable angina

Question 27

Adverse drug reactions of calcium channel blockers

Answer 27

Ankle oedema Headache Flushing Palpitation

Question 28

Example of nitrovasodilators

Answer 28

Glyceryl trinitrate (GTN) Isosorbide mononitrate Isosorbide dinitrate

Question 29

Function of nitrovasdilators

Answer 29

Relax almost all smooth muscle cells via NO and cGMP

Question 30

Effect of nitorvasodilators

Answer 30

Reduce afterload and preload Relieving coronary vasospasm Redistributing myocardial blood flow to ischaemic areas

Question 31

Adverse drug reactions of nitrates

Answer 31

Headache Hypotension GTN - syncope

Question 32

Drug for metabolic modulation

Answer 32

Trimetazidine

Question 33

Drug for sinus node inhibition

Answer 33

Ivabradine

Question 34

Drug for late sodium current inhibition

Answer 34

Ranolazine

Question 35

Drug for preconditioning

Answer 35

Nicorandil

Question 36

Second line therapy

Answer 36

Nicorandil Ibabradine Ranolazine

Question 37

Function of nicorandil

Answer 37

Activates ATP sensitive potassium channel, the entry of potassium into myocytes inhibits calcium influx and so negative inotropic action

Question 38

Effect of nicorandil

Answer 38

Relaxation of vascular smooth muscle and coronary dilation | Decreases preload and afterload

Question 39

Function of ivabradine

Answer 39

Inhibits If pacemaker in the sinoatrial node, slows diastolic depolarisation slip of SA-node

Question 40

Effect of ivabradine

Answer 40

Reduces heart rate

Question 41

Ivabradine is used in combination with

Answer 41

Beta-blockers

Question 42

Function of ranolazine

Answer 42

Inhibits sodium inward current in heart muscle in voltage gated channels leading to reduced intracellular calcium levels

Question 43

Effect of ranolazine

Answer 43

Reduced tension in the heart wall

Question 44

Aspirin dosage

Answer 44

75-100mg

Question 45

Function of aspirin

Answer 45

Inhibits platelet thromboxane production which stimulates platelet aggregation and vasoconstriction

Question 46

Effect of aspirin

Answer 46

Stops aggregation of platelets

Question 47

Aspirin is combined with

Answer 47

Beta blockers

Question 48

Aspirin and clopidogrel reduce

Answer 48

Acute MI and unstable angina mortality, reinfarction

Question 49

Risk of aspirin and clopidogrel

Answer 49

GI bleed

Question 50

Function of clopidogrel

Answer 50

Inhibits ADP receptor activated platelet aggregation

Question 51

Effect of clopidogrel

Answer 51

Prevents platelet aggregation

Question 52

Examples of cholesterol lowering agents

Answer 52

Simvastatin Pravastatin Atorvastatin

Question 53

Function of cholesterol lowering agents

Answer 53

HMG CoA reductase inhibitors

Question 54

First line therapy

Answer 54

Beta blockers

Question 55

Patients with stable angina should be considered for treatment with

Answer 55

ACE inhibitor