DRUGS FOR ISCHEMIC HEART DISEASE Textbook notes

What is the focus of pharmacologic management for ischemic heart disease?

It focuses on appropriate management for each stage—angina relief vs mortality benefit.

Which drug class is first-line for chronic stable angina?

β-Blockers.

How do nitrates work to relieve angina?

They release nitric oxide, activating guanylate cyclase, increasing cGMP, which relaxes vascular smooth muscle and improves coronary flow.

What is the mechanism of action for β-blockers?

They antagonize β₁-receptors, reducing heart rate, contractility, and blood pressure, thereby lowering myocardial oxygen demand and infarct risk.

What condition are β-blockers contraindicated in?

Vasospastic (variant) angina.

What are dihydropyridines used for in ischemic heart disease?

They provide vascular dilation.

Which drugs block L-type Ca²⁺ channels?

Calcium Channel Blockers (CCBs).

What is the purpose of ranolazine in ischemic heart disease management?

It reduces late Na⁺ current to improve diastolic function and is used as an add-on or β-blocker alternative.

What side effects can β-blockers cause in diabetics?

They may mask hypoglycemia.

What is the recommended treatment for acute ischemia?

Short-acting nitrates and a β-blocker.

Which drugs can be combined with β-blockers if symptoms persist?

Calcium channel blockers or long-acting nitrates.

What is ivabradine used for?

It lowers heart rate without affecting blood pressure or contractility.

What is the significance of nitrates developing tolerance?

Tolerance can develop, requiring strategies like daily nitrate-free intervals.

What risks are associated with the use of calcium channel blockers?

Hypotension, edema, and constipation (especially with verapamil).

What are the vital agents for secondary prevention post-acute events?

Antiplatelets (aspirin, P2Y₁₂ inhibitors) and statins.

What is the potential downside of using ranolazine?

It may cause QT prolongation.

How do nitrates affect coronary flow?

By reducing preload through vascular smooth muscle relaxation.

What is the goal heart rate when titrating treatments for ischemic heart disease?

Approximately 55–60 bpm.

What are “Opiegram summaries” used for?

They illustrate mechanisms and comparative drug profiles for efficient learning.