#11 - Treatment of stable angina (Brown) Flashcards
What are the 4 main groups of agents used for treatment of stable angina?
- aspirin
- nitrates
- calcium channel blocking agents
- Beta blockers
What are the 2 bradycardic Ca channel blockers?
verapamil and diltiazem.
They also lower contractility.
Which Ca channel blocker is the most commonly used, and doesn’t depress cardiac function, HR, or AV conduction?
Amlodipine.
It is a dihydropyridine
How do beta blockers work for stable angina?
slows the heart down when you’re exerting yourself, so you can exert without as much angina.By slowing down the heart rate, they reduce myocardial oxygen requirements (MVO2)
What are the main 2 beta selective drugs?
metoprolol, atenolol
What does B1 selectivity mean in regards to a B blocker?
B1 = acts only on the heart (not on bronchioles or elsewhere). Make sure to use B1 selectives for diabetics.
Who should you always use B1 selective B blockers for?
diabetics.
What are the 2 most common non-selective B blockers?
carvedilol and labetalol. They are both also short acting, and have A1 blocking property.
How do Ca channel blockers affect symptoms/ mortality of stable angina patients?
They help symptoms but not mortality.
How does aspirin affect symptoms/ mortality of stable angina patients?
it doesn’t improve day to day symptoms but reduces cardiac events/mortality.
How do B blockers affect symptoms/ mortality of stable angina patients?
Beta blockers improve symptoms AND improve life expectancy for patients with acute MI, if started within a few days of admission.!! This is why everybody leaves the hospital with a beta blocker.
Does not help for people with remote MIs (>5 yrs ago) or who haven’t had an MI.
When is revascularization used for angina?
It is used in patients where all other medications are ineffective at reducing the symptoms. .
Who benefits from improved life expectancy with revascularization?
if left main artery is affected, always.
Also, If 3 vessels are affected AND there is either decreased ventricular systolic function OR severe symptoms, these patients will have increased survival
Stable angina patient. You do treatmill test. It is positive, but not markedly so (you have to make them exert hard to get signs.) What is next?
Medical treatment or elective angioplasty.
Stable angina patient. You do treatmill test. It is markedly positive. What is next?
They need angiography!!
