Title Farmakološka terapija stabilne angine pektoris Title (english) Pharmacological therapy of stable angina pectoris Author Aneta Suhi Mentor Lidija Bach-Rojecky (mentor)Committee member Lidija Bach-Rojecky (predsjednik povjerenstva)Committee member Petra Turčić (član povjerenstva)Committee member Andrea Brajković (član povjerenstva)Granter University of Zagreb Defense date and country 2024-07-16, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Stabilna angina pektoris predstavlja najčešću kliničku manifestaciju ishemijske bolesti srca, a povezana je s narušenom kvalitetom života i povećanim rizikom od štetnih kardiovaskularnih događaja. Važno je prepoznati njezine simptome i započeti s liječenjem koje ima dva glavna cilja. Prvi od njih je sprječavanje ili smanjenje pojave anginoznih simptoma te poboljšanje kvalitete života, dok je drugi cilj prevencija ozbiljnih kardiovaskularnih događaja. Patofiziološku podlogu čini prisutna opstruktivna koronarna arterijska bolest, odnosno prisutnost aterosklerotskih plakova u epikardijalnim koronarnim arterijama zbog čega se javlja neravnoteža između potrebe srca za kisikom i opskrbe srca kisikom. Farmakološka terapija stabilne angine uključuje primjenu antiishemijskih lijekova, kojima se nastoji uspostaviti ravnoteža između opskrbe srca kisikom i potrebe srca za kisikom, te lijekova koji preveniraju kardiovaskularne događaje. Među antiishemijskim lijekovima razlikuju se lijekovi prve i druge linije liječenja, pri čemu se u prvu liniju ubrajaju β-blokatori, blokatori kalcijevih kanala i kratkodjelujući nitrati. Uz dugodjelujuće nitrate, lijekovima druge linije smatraju se nikorandil, ranolazin, trimetazidin i ivabradin. Lijekovi druge linije se koriste u slučaju prisutnih kontraindikacija na lijekove iz prve linije, u slučaju njihove nepodnošljivosti ili ako se prvom linijom ne može postići dobra kontrola simptoma. Pri tome je važno istaknuti kako ne postoje usporedbe između prve i druge linije koje bi pokazale superiornost jedne skupine nad drugom u pogledu učinkovitosti. Od lijekova koji preveniraju kardiovaskularne događaje značajni su antiagregacijski lijekovi (acetilsalicilna kiselina, P2Y12 antagonisti), statini i ACE inhibitori. Revaskularizacija miokarda može se razmotriti kod bolesnika koji imaju prognostički značajne lezije ili simptome unatoč optimalnoj farmakološkoj terapiji, pri čemu je moguće izvesti perkutanu koronarnu intervenciju, premoštenje koronarnih arterija ili oboje.
Abstract (english) Stable angina pectoris represents the most common clinical manifestation of ischemic heart disease, and is associated with impaired quality of life and increased risk of adverse cardiovascular events. It is important to recognize its symptoms and start treatment, which has two main goals. The first of them is the prevention and reduction of anginal symptoms and the improvement of quality of life, while the second goal is the prevention of serious cardiovascular events. The pathophysiological basis is the presence of obstructive coronary artery disease, that is, the presence of atherosclerotic plaques in the epicardial coronary arteries, which causes an imbalance between the heart's need for oxygen and the heart's oxygen supply. Pharmacological therapy of stable angina pectoris includes use of anti-ischemic drugs which try to restore balance between the heart's oxygen supply and the heart's need for oxygen, and drugs that prevent cardiovascular events. Among anti-ischemic drugs, first- and second-line drugs are distinguished, whereby β-blockers, calcium channel blockers and short-acting nitrates are included in the first line. In addition to long-acting nitrates, second-line drugs include nicorandil, ranolazine, trimetazidine, and ivabradine. Second-line drugs are used in case of contraindications for first-line drugs, in case of their intolerance or if good control of symptoms cannot be achieved with the first-line drug. It is important to point out that there are no comparisons between the first- and second-line drugs that would show the superiority of one group over the other in terms of effectiveness. Among the drugs that prevent cardiovascular events, antiplatelet drugs (acetylsalicylic acid, P2Y12 antagonists), statins and ACE inhibitors are important. Myocardial revascularization may be considered in patients who have prognostically significant lesions or symptoms despite optimal pharmacology therapy, where percutaneous coronary intervention, coronary artery bypass grafting or both can be performed.
Keywords
angina pektoris
ishemijska bolest srca
opstruktivna koronarna arterijska bolest
aterosklerotski plakovi
farmakoterapija
antiishemijski lijekovi
antiagregacijski lijekovi
statini
ACE inhibitori
Keywords (english)
angina pectoris
ischemic heart disease
obstructive coronary artery disease
atherosclerotic plaques
pharmacotherapy
antiischemic drugs
antiplatelet drugs
statins
ACE inhibitors
Language croatian URN:NBN urn:nbn:hr:163:281380 Study programme Title: Pharmacy - integrated undergraduate and graduate - university study Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-09-25 10:47:56
