Pharmacology

Case study:
Mr Chencho, a 65yr old man has been having episodes of chest pain during exercise and
walking uphill but is relieved by rest. Diagnosis of angina is made and was started on medical
treatment. The frequency and intensity of the pains had become worse and were now
occurring several times a week. He is hypertensive, and his serum cholesterol is 6.6mmol/L.
He smokes 40 cigarettes per day and is overweight. He drinks about 10 units of alcohol a
week.

1. Six months later, despite continuing medication, he woke up with severe chest pain
and dyspnea, how could his acute attack of angina be treated?
Ans: His acute attack of angina can be treated by
- Complete bed rest.
- Oxygen inhalation
- Administer sublingual GTN
- Analgesia( intravenous morphine sulphate 5-10mg)

2. What is angina and what typical symptoms could a patient present with?
Ans: Angina (also known as Angina pectoris) is not a disease but a symptom of myocardial
ischemia produced in a variety of ways. It develops as a result of an imbalance between the
oxygen supply and the oxygen demand of the myocardium.
Its occurrence depends upon two factors:
● Coronary blood flow.
● Oxygen consumption by the myocardium.
The signs and symptoms an angina patient could have are:
- retrosternal pain,
- heaviness or discomfort which may radiate to the neck, shoulder, back or the arm. It
occurs typically during exercise, severe cold or stress.
- Dizziness, fatigue, nausea, shortness of breath, sweating.
3. What are the risk factors associated with developing angina in mr. Chencho?
Ans: The risk factors associated with developing angina in Mr. Chencho are:
● Obesity
● Old age
● Smoking
● Hypertension
● High blood cholesterol
● Drinking alcohol
4. What group of drugs does GTN spray belong to? How does it help in angina? What are
the side-effects of GTN?
Ans: Glyceryl trinitrate (GTN) is spray used to relieve angina. It belongs to a group of
medicines called Nitrates.
It exert a direct relaxant effect on smooth muscles. They are reduced to organic nitrites
which are then converted to nitric oxide (NO) which is a vasodilator. They reduce the heart
load by markedly dilating venous vessels. They are rapidly absorbed from the sublingual
mucosa and are slowly absorbed from the intestinal mucosa.
The side-effects of GTN are:
● Headache
● Nausea and vomiting
● postural hypotension
● dizziness and increased heart rate
● tolerance development.

5. Once the acute attack is stabilized with a drug X, he would require other drugs in the
long run to prevent the attacks. What are the other important options available and
why?
Ans: The other options are:
● Antihypertensive drugs to control hypertension.
● Antiplatelet (aspirin and clopidogrel) to prevent clottings.
● Statins to reduce cholesterol level.
● β-adrenergic blocking agent because they prevent anginal attacks by reducing the
oxygen demand of the myocardium. This is accomplished by diminishing the cardiac
response to sympathetic stimulation and by other complex mechanisms
-
 ● 3. Calcium channel blockers as they are in longer acting form and are potent dilators
of coronary artery and are important in the treatment of angina due to coronary
vasospasm. Their use in the treatment of classical angina appears by reducing
peripheral vascular resistance and myocardial contractility. They improve balance
between myocardial oxygen supply & demand, as well as can be used to those
patient who cannot tolerate β-blockers.
● 4. Potassium channel activators as they act on the ion channels of the vascular
smooth muscle cell and cardiac myocyte.

6. What additional drug might be helpful for prognosis?

Ans: therefore the additional drugs helpful for prognosis are:
● statins
● ACE-inhibitor
● Aspirin
● β-adrenergic blocking agent.
● 3. Calcium channel blockers.
● 4. Potassium channel activators

Name: Binu Mongar

GNM 1ST year 2nd semester
Registration no: DIP/2019/00930