Uses Of Drugs

Question 1

Therapeutic use of nitrate

Answer 1

1. Acute angina
   2.P/I of stable angina
   3.variant angina
   4.unstable angina
   5.MI
   6.CCF
   7.Hypertensive emergency
   8.biliary colic
   9.cyanide poisoning

1.nitriglycerine DOC acute angina
Sublingual tablet

2.p/o isosorbide mononitrate long action
Decrease freq. of attack ↑ exercise tolerance

3.variant angina - vasospasm- relief by nitroglycerin , for p/o nitrate and CCB

4. Unstable angina-
   Antiplatelet - low dose aspirin
   Anticoagulant - low dose/ unfrac. heparin
   Nitrate relief spasm
   Beta#
   CCB
   Statin

5.MI . Nitrate avoid in pt. c sildenafil,tadafil in past 24hr

6.ccf nitrate fir acute heart failure

Cyanide ( inhibit cytochrome oxidase)poisoning - amyl nitrate convert haemoglobin – methaemoglobin—- cyanomethaemoglobin—-( i.v. sodium thiosulphate)— sodium thiocyanate ( excreted in urine)

Question 2

Pharmacological action CCB

Answer 2

Verapamil-
negative inotropic( foc) and chronotropic (HR) and dromotropic( av cond.)
Depress SA node

Diltiazem- dilate peripheral and coronary arteries also negative for all
Use in HNT SVA p/o of angina

DHPs more selective to myocardium
Relax vsm= coronary dilation
↓ pvr ↓ afterload
↓ O2 consumption

Nifedipine
Rapid vasodilation
Fall in bp
Reflex tachycardia,flushing, palpitations ( use beta#)

Amlodipine - over DHF
more potent
Longer duration
Dilate both peripheral and coronary vessel
High oral BA and absorbed slowly after administration.

Question 3

Therapeutic use of CCB

Answer 3

Exertional angina
Variant angina relief coronary spasm
Unstable angina when symptoms not relief by nitrate nd beta#

Question 4

Therapeutic use of beta#

Answer 4

Useful in P/O
improve exercise tolerance and reduce freq of angina

Beta blockers c intrinsic sympathomimetic activity (pindolo) should be avoided they worsen agina

Coronary artery has a1 and B2 adrenegic receptors blockage of B2 result in ↑ a1 - vasoconstriction ↑ angina