CVS - ANGINA
31 important questions on CVS - ANGINA
What are some risk factors to avoid or treat for the prevention of IHD?
- Smoking
- High Fat Diet
- Hypertension
- Diabetes
- Hyperlipidemia
- Thyrotoxicosis
- etc
What medications are used for unstable angina?
- Beta-blocker, CCB, and Organic Nitrates are used for unstable angina.
- Anti-platelet drugs like Low dose Aspirin 75mg decrease thrombosis incidence.
- Anticoagulation example: Heparin IV.
How can the risk and progression to MI be reduced?
- Use anti-platelet drugs, e.g. Low dose Aspirin
- Use hypolipidemic agents, e.g. Statins, Fibrates
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What is used for an acute attack of Typical Stable Angina?
- Nitroglycerine spray or tab
- Isosorbide (mononitrate active metabolite) SL tabs
What surgical procedures are used for unstable angina?
- Revascularization to restore blood flow.
- Angioplasty surgery involves using a balloon to stretch a blocked artery, e.g., to prevent MI.
What are the clinical uses of Propranolol?
- Stable & Unstable Angina
- Hypertension
- Arrhythmia
- Tremors
- Thyrotoxicosis
What is used for prophylaxis in Typical Stable Angina?
- Long-acting nitrates like isosorbide dinitrate
- Sustained release formulations (duration 12 hours or more)
- Other drugs: Amyl nitrate, β-blocker, or CCB
What are the clinical uses of Amlodipine?
- Stable & Vasospastic Angina pectoris
- Hypertension
What is done if there is an inadequate response to a single drug in Typical Stable Angina?
- Another drug from a different class is added to increase beneficial effects and decrease undesirable effects.
What are the common side effects of Amlodipine?
- Headache
- Nervousness
- Dizziness
- Constipation
- Peripheral oedema
- Etc
What are the clinical uses of Atenolol, Nadolol, Metoprolol, and Celiprolol?
- Stable & Unstable Angina
- Hypertension
What is the pharmacologic management for Vasospastic Angina?
- Organic Nitrate + CCB
What do Calcium Channel Blockers (CCBs) and β1-adrenoceptor blockers target?
- Calcium Channel Blockers (CCBs) target the LTCC (L-type calcium channels).
- β1-adrenoceptor blockers target β1-AR (beta-1 adrenergic receptors).
- Nifedipine, verapamil, diltiazem are examples of CCBs.
- Noradrenaline interacts with β1-AR.
- cAMP and cAMP-PK are involved in the signaling pathway.
- SR (sarcoplasmic reticulum) stores Ca²⁺.
- PLN and SERCA are involved in calcium regulation.
- RyR (ryanodine receptor) releases Ca²⁺ for contraction.
What are the clinical uses of Nifedipine?
- Vasospastic & Stable Angina
- Hypertension (SR preps only)
What are the drug names listed under Organic Nitrates?
- Glyceryl Trinitrate (GTN); Tab/spray
- Nitroglycerine SL, Spray or IV
- Amyl nitrate
- Isosorbide dinitrate
Why are Beta-blockers contraindicated in Vasospastic Angina?
- They are contraindicated because they produce coronary spasm.
What are the common side effects of Atenolol, Nadolol, Metoprolol, and Celiprolol?
- Bradycardia
- Bronchospasm
- Hypotension
- Depression
- Impotence
- Urine retention
- Mask glycemic symptoms
- Cold extremities
What are the classes of anti-angina drugs?
- Organic Nitrates
- Calcium channel blockers
- β-adrenoceptor antagonists (β-blockers)
- ACE inhibitors
Describe the mechanism of action for Organic Nitrates.
What are the common side effects of Nifedipine?
- Dizziness
- Light-headedness
- Headache
- Nervousness
- Constipation
- AV block
- Flushing
- Rash
- Etc
What are the clinical uses of Diltiazem and Verapamil?
- Angina
- HTN
- Arrhythmia
- Atrial fibrillation or flutter
What are some modifiable and non-modifiable risk factors?
- Unhealthy cholesterol levels (Dyslipidemia)
- High blood pressure
- Smoking
- Diabetes
- Obesity or overweight
- Inactivity
- Unhealthy diet
- Old age-men > 45 years, women > 55 years
- Family history
What are the pharmacological effects of Organic Nitrates?
- Reduce preload & afterload
- Decrease myocardial workload resulting in decreased myocardial O2 demand
What is Typical Stable Angina also known as?
List the side effects associated with Organic Nitrates.
- Orthostatic hypotension
- Reflex tachycardia
- Severe throbbing headache
- Flushing
- Dizziness & Syncope
What are the common side effects of Diltiazem and Verapamil?
- Nausea
- Diarrhea
- Edema
- Angina
- Bradycardia
- AV block
- Flushing
- Rash
- Headache
What causes angina according to the pathophysiology of angina pectoris?
What triggers Variant Angina and when does it usually occur?
What factors contribute to increased oxygen demand in angina pectoris?
- Increased heart rate
- Increased ventricular wall tension
- Increased ventricular contractility
- Exertion & Emotional stress
What is Unstable Angina also referred to as?
What factors contribute to decreased oxygen supply in angina pectoris?
- Decreased coronary blood flow
- Fixed Atherosclerotic narrowing
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