Angina Flashcards
What are the short acting nitrates?
GTN
Isosorbide dinitrate
What is the condition that GTN and isosorbide dinitrate are used for?
Acute angina attacks
What are the long acting nitrates?
MR isosorbide dinitrate
Isosorbide mononitrate
What medications are used for the long term prophylaxis of angina?
Beta blockers Calcium channel blockers Ivabradine Ranolazine Nicorandil MR isosorbide dinitrate Isosorbide mononitrate
How does GTN work?
Converted to nitric oxide which is a short acting vasodilator
Improves blood supply
How long do the effects of GTN tablet/spray last?
20-30 minutes
When should you consider long term prophylaxis for angina?
If using GTN more than twice a week
How do you take GTN?
When required or before angina inducing activities e.g. exercise
Take sitting down as dizziness can occur
1st - then wait 5 minutes
2nd - then wait 5 minutes
3rd - wait 5 minutes
If pain still present 999 - medical emergency
What are the angina prophylaxis drugs that can be used together?
B blocker or CCB
B blocker + dihydropyridine CCB
Long acting nitrate
Ivabradine
Ranolazine
Nicorandil in adults only
What is the MHRA warning for nicorandil?
Now given second line as risk of ulcer complications - mouth, skin, eye, GI
Do not drive until it is established performance is not impaired
What is the mechanism of action of nitrates?
Nitrates are potent coronary vasodilators and reduce venous return and cardiac output
What are the short acting nitrates?
GTN
What are the long acting nitrates?
Isosorbide mononitrate BD (MR OD)
MR isosorbide dinitrate BD
What is the nitrate free period?
With long acting preparations or transdermal patches
Leave patches off for 8-12 hours
Take second dose after 8 hours not 12 hours
MR isosorbide mononitrate is taken OD
What are the side effects of nitrates?
Vasodilation
Flushing
Throbbing headache
Dizziness
