45 - Stable Angina

Question 1

non-pharms

Answer 1

• aggressive lifestyle intervention

- revascularization (PCI or CABG)

Question 2

List 3 classes of drugs used to decrease or prevent angina

Answer 2

• Nitrates
• Beta blockers
• CCBs

*any of these are 1st line but everyone should have SL nitroglycerin on hand for tx of acute angina attack

Question 3

How do nitrates work?

Answer 3

reduce preload and myocardial oxygen demand

Question 4

Long-acting formulations of nitrates frequently case _______

Answer 4

headache

Question 5

Tolerance to the anti-anginal effects of nitrates develops unless a nitrate free period of _____ hours is prescribed each day

Answer 5

10-12

Question 6

How do BBs work?

Answer 6

decrease HR, contractility and BP

they prevent and decrease angina by decreasing myocardial oxygen demand

Question 7

What type of CCB act similar to BBs?

Answer 7

Non-DHPs:

-act more centrally and behave similar to BBs (decrease oxygen demand by decreasing HR, contractility and BP)

Question 8

How do DHP CCBs work?

Answer 8

primarily cause arterial dilation

Question 9

Examples of Non-DHPs

Answer 9

diltiazem, verapamil

Question 10

Example of DHPs

Answer 10

amlodipine, felodipine, nifedipine

Question 11

All 3 DHPs have been used for this indication but which DHP does not have approval for stable angina?

Answer 11

felodipine

Question 12

Other agents:

How does Nicorandil work?

Answer 12

dilates arterioles and veins

Question 13

Other agents:

How does Ranolazine work?

Answer 13

decreases calcium overload

Question 14

Other agents:

How does Trimetazidine work?

Answer 14

inhibits fatty acid oxidation

Question 15

Other agents:

How does Ivabradine work?

Answer 15

inhibits If current

Question 16

Which of the “other agents” listed has approval in HC?

Answer 16

only ivabradine which is approved for patients with HF

Question 17

Patients with stable angina can benefit from drugs that decrease risk of CV death and non fatal MI. Which drug classes are used for this purpose?

Answer 17

• antiplatelet therapy
• statin tx
• ACEi

Question 18

Which antiplatelet does not require hepatic activation?

Answer 18

ticagrelor

Question 19

What are some drugs that increase risk of CV death and nonfatal MI and should not be used?

Answer 19

• hormone therapy

- COX-2 inhibitors and most NSAIDs

Question 20

For prinzmetal angina, what should you use?

Answer 20

use CCB or nitrates

*avoid BBs