Pharmacology Lecture: Stable Ischemic Heart Disease
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Questions and Answers

What is the main symptom of angina pectoris?

  • Back spasms
  • Severe head pain
  • Leg cramps
  • Severe chest pain (correct)

    • What are the three types of angina pectoris?

    Stable, unstable, variant

    Nitrates cause dilation of __________ arteries to increase oxygen supply.

    coronary

    Match the pharmacokinetic factor to the type of nitrate therapy:

    <p>Sublingual nitroglycerin = Short-acting Transdermal patch nitroglycerin = Long-acting Oral isosorbide dinitrate = Long-acting</p> Signup and view all the answers

    What is the main symptom of angina pectoris?

    <p>severe chest pain</p> Signup and view all the answers

    Which type of angina has a regular pattern and is the most common?

    <p>Stable angina</p> Signup and view all the answers

    Angina pectoris results in permanent damage to the heart muscle.

    <p>False</p> Signup and view all the answers

    Organic nitrates release ___, responsible for vasodilatation.

    <p>nitric oxide</p> Signup and view all the answers

    Match the following contraindications with the use of nitrates:

    <p>Recent surgery = retard healing of the wound Ischemic stroke = risk of bleeding Warfarin therapy = contraindicated</p> Signup and view all the answers

    What is the main symptom of angina pectoris?

    <p>Severe chest pain</p> Signup and view all the answers

    Which type of angina is most common and occurs if the heart is working harder than usual?

    <p>Stable angina</p> Signup and view all the answers

    Angina pectoris results in permanent damage to the heart muscle.

    <p>False</p> Signup and view all the answers

    Nitrates cause dilation of ______ arteries to increase oxygen supply.

    <p>coronary</p> Signup and view all the answers

    Match the following nitrate types with their mode of administration:

    <p>Sublingual nitroglycerin = Short-acting Transdermal nitroglycerin patch = Long-acting Inhalation amyl nitrite = Short-acting Oral isosorbide dinitrate = Long-acting</p> Signup and view all the answers

    Study Notes

    Stable Ischemic Heart Disease (SIHD)

    • Professor Hany A. Omar's lecture objectives:
      • Understand rationale for drug therapy in ischemic heart diseases
      • Know classes of drugs used to treat myocardial infarction
      • Mode of action of nitrates
      • Pharmacokinetics of nitrates and their formulations and delivery methods
      • Clinical uses and common side effects of nitrates
      • Concept of nitrate tolerance
      • Different types of fibrinolytics and their mechanisms of action

    Angina Pectoris

    • Ischemic myocardial pain resulting from imbalance between oxygen supply and demand
    • Main symptoms:
      • Severe chest pain due to ischemia of the heart muscle
      • Pain extending to shoulders, arms, neck, jaw, or back
      • Feeling like pressure or squeezing in the chest
    • Types of angina:
      • Stable (effort) angina: occurs with physical effort, relieved by rest, and has a regular pattern
      • Unstable angina: occurs with increased frequency, precipitated by less effort, and may not be relieved by rest or nitroglycerin
      • Variant (Prinzmetal's) angina: rare, occurs due to coronary vasospasm, usually at rest, and relieved by medicine

    Differences between Angina Pectoris and Myocardial Infarction

    • Angina pectoris: reversible process, no permanent damage to the muscle
    • Myocardial infarction: ischemic necrosis due to total occlusion of coronary artery, irreversible changes in muscle

    Treatment of Angina Pectoris

    • Treatment lines include:
      • Vasodilators (increase oxygen supply)
      • Agents that decrease oxygen demand (decrease myocardial work)
    • Examples:
      • Organic nitrates (e.g., Isosorbide dinitrate, Glyceryltrinitrate/Nitroglycerin)
      • Mechanism of action: release nitric oxide, which vasodilates blood vessels, increases oxygen supply, and decreases oxygen demand

    Nitrates & Nitrites

    • Cardiovascular effects:
      • Vasodilatation in veins, arteries, and coronaries
      • Decrease preload, ventricular filling pressure, cardiac work, and oxygen demand
    • Antiplatelet aggregation effect: NO stimulates increase in cGMP in platelets, decreasing platelet aggregation
    • Pharmacokinetics:
      • Short-acting: sublingual (Nitroglycerin, Isosorbide dinitrate), inhalation (Amyl nitrite)
      • Long-acting: oral sustained-release nitrite (Nitroglycerin), transdermal patches (Nitroglycerin), oral (Isosorbide dinitrate)
    • Contraindications:
      • Hypotension (systolic < 180 or diastolic < 110)
      • Recent surgery
      • Warfarin therapy
      • Active peptic ulcer
      • Diabetic retinopathy and history of hypertension
      • Ischemic stroke (?)

    Fibrinolytic Agents

    • Complications:
      • Bleeding (most common)
      • Intra-cranial hemorrhage (most serious, 0.5-0.7%)
      • Liberation of platelets and thrombin from the clot, potentially causing another clot in other sites
    • Interactions:
      • Aspirin and heparin increase activity and risk of bleeding of fibrinolytics
    • Examples:
      • Streptokinase: protein produced by streptococci, forms a complex with plasminogen, converting it to plasmin
      • Complications and adverse effects:
        • Allergic reactions in patients with prior exposure to streptococci

    Stable Ischemic Heart Disease (SIHD)

    • Professor Hany A. Omar's lecture objectives:
      • Understand rationale for drug therapy in ischemic heart diseases
      • Know classes of drugs used to treat myocardial infarction
      • Mode of action of nitrates
      • Pharmacokinetics of nitrates and their formulations and delivery methods
      • Clinical uses and common side effects of nitrates
      • Concept of nitrate tolerance
      • Different types of fibrinolytics and their mechanisms of action

    Angina Pectoris

    • Ischemic myocardial pain resulting from imbalance between oxygen supply and demand
    • Main symptoms:
      • Severe chest pain due to ischemia of the heart muscle
      • Pain extending to shoulders, arms, neck, jaw, or back
      • Feeling like pressure or squeezing in the chest
    • Types of angina:
      • Stable (effort) angina: occurs with physical effort, relieved by rest, and has a regular pattern
      • Unstable angina: occurs with increased frequency, precipitated by less effort, and may not be relieved by rest or nitroglycerin
      • Variant (Prinzmetal's) angina: rare, occurs due to coronary vasospasm, usually at rest, and relieved by medicine

    Differences between Angina Pectoris and Myocardial Infarction

    • Angina pectoris: reversible process, no permanent damage to the muscle
    • Myocardial infarction: ischemic necrosis due to total occlusion of coronary artery, irreversible changes in muscle

    Treatment of Angina Pectoris

    • Treatment lines include:
      • Vasodilators (increase oxygen supply)
      • Agents that decrease oxygen demand (decrease myocardial work)
    • Examples:
      • Organic nitrates (e.g., Isosorbide dinitrate, Glyceryltrinitrate/Nitroglycerin)
      • Mechanism of action: release nitric oxide, which vasodilates blood vessels, increases oxygen supply, and decreases oxygen demand

    Nitrates & Nitrites

    • Cardiovascular effects:
      • Vasodilatation in veins, arteries, and coronaries
      • Decrease preload, ventricular filling pressure, cardiac work, and oxygen demand
    • Antiplatelet aggregation effect: NO stimulates increase in cGMP in platelets, decreasing platelet aggregation
    • Pharmacokinetics:
      • Short-acting: sublingual (Nitroglycerin, Isosorbide dinitrate), inhalation (Amyl nitrite)
      • Long-acting: oral sustained-release nitrite (Nitroglycerin), transdermal patches (Nitroglycerin), oral (Isosorbide dinitrate)
    • Contraindications:
      • Hypotension (systolic < 180 or diastolic < 110)
      • Recent surgery
      • Warfarin therapy
      • Active peptic ulcer
      • Diabetic retinopathy and history of hypertension
      • Ischemic stroke (?)

    Fibrinolytic Agents

    • Complications:
      • Bleeding (most common)
      • Intra-cranial hemorrhage (most serious, 0.5-0.7%)
      • Liberation of platelets and thrombin from the clot, potentially causing another clot in other sites
    • Interactions:
      • Aspirin and heparin increase activity and risk of bleeding of fibrinolytics
    • Examples:
      • Streptokinase: protein produced by streptococci, forms a complex with plasminogen, converting it to plasmin
      • Complications and adverse effects:
        • Allergic reactions in patients with prior exposure to streptococci

    Stable Ischemic Heart Disease (SIHD)

    • Professor Hany A. Omar's lecture objectives:
      • Understand rationale for drug therapy in ischemic heart diseases
      • Know classes of drugs used to treat myocardial infarction
      • Mode of action of nitrates
      • Pharmacokinetics of nitrates and their formulations and delivery methods
      • Clinical uses and common side effects of nitrates
      • Concept of nitrate tolerance
      • Different types of fibrinolytics and their mechanisms of action

    Angina Pectoris

    • Ischemic myocardial pain resulting from imbalance between oxygen supply and demand
    • Main symptoms:
      • Severe chest pain due to ischemia of the heart muscle
      • Pain extending to shoulders, arms, neck, jaw, or back
      • Feeling like pressure or squeezing in the chest
    • Types of angina:
      • Stable (effort) angina: occurs with physical effort, relieved by rest, and has a regular pattern
      • Unstable angina: occurs with increased frequency, precipitated by less effort, and may not be relieved by rest or nitroglycerin
      • Variant (Prinzmetal's) angina: rare, occurs due to coronary vasospasm, usually at rest, and relieved by medicine

    Differences between Angina Pectoris and Myocardial Infarction

    • Angina pectoris: reversible process, no permanent damage to the muscle
    • Myocardial infarction: ischemic necrosis due to total occlusion of coronary artery, irreversible changes in muscle

    Treatment of Angina Pectoris

    • Treatment lines include:
      • Vasodilators (increase oxygen supply)
      • Agents that decrease oxygen demand (decrease myocardial work)
    • Examples:
      • Organic nitrates (e.g., Isosorbide dinitrate, Glyceryltrinitrate/Nitroglycerin)
      • Mechanism of action: release nitric oxide, which vasodilates blood vessels, increases oxygen supply, and decreases oxygen demand

    Nitrates & Nitrites

    • Cardiovascular effects:
      • Vasodilatation in veins, arteries, and coronaries
      • Decrease preload, ventricular filling pressure, cardiac work, and oxygen demand
    • Antiplatelet aggregation effect: NO stimulates increase in cGMP in platelets, decreasing platelet aggregation
    • Pharmacokinetics:
      • Short-acting: sublingual (Nitroglycerin, Isosorbide dinitrate), inhalation (Amyl nitrite)
      • Long-acting: oral sustained-release nitrite (Nitroglycerin), transdermal patches (Nitroglycerin), oral (Isosorbide dinitrate)
    • Contraindications:
      • Hypotension (systolic < 180 or diastolic < 110)
      • Recent surgery
      • Warfarin therapy
      • Active peptic ulcer
      • Diabetic retinopathy and history of hypertension
      • Ischemic stroke (?)

    Fibrinolytic Agents

    • Complications:
      • Bleeding (most common)
      • Intra-cranial hemorrhage (most serious, 0.5-0.7%)
      • Liberation of platelets and thrombin from the clot, potentially causing another clot in other sites
    • Interactions:
      • Aspirin and heparin increase activity and risk of bleeding of fibrinolytics
    • Examples:
      • Streptokinase: protein produced by streptococci, forms a complex with plasminogen, converting it to plasmin
      • Complications and adverse effects:
        • Allergic reactions in patients with prior exposure to streptococci

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    Related Documents

    Stable Ischemic Heart Disease (SIHD) Pharmacology PDF

    Description

    This lecture on stable ischemic heart disease (SIHD) covers the rationale for drug therapy and its applications. By the end of this lecture, students will understand the key concepts of SIHD and its pharmacological treatment.

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