Angina Flashcards
Most common cause of angina
Coronary occlusion due to atherosclerosis
Angina Classification
predictable and reproducible. Relieved by rest or nitroglycerin
Stable Angina
Angina classification
angina at rest (usually lasting more than 20 min), new onset angina, or increasing angina
Unstable Angina
Suggestive of acute coronary syndrome without troponin elevation
Angina classification
angina at rest relieved by nitroglycerin
Vasospastic (Prinzmetal) Angina
Non-pharm trmnt of Angina
Diet
Exercise
Smoking cessation
HTN management
Medical procedures
Pharm trmnts of Angina
Aspirin (low-dose)
Statin
Anti-anginal agents
Beta Blockers
Calcium Channel Blockers (CCBs)
Nitroglycerin
Isosorbide mono/dinitrate
Ranolazine
1st line agent for Angina
Beta Blockers
- Reduce heart rate and contractility
- Minimal effect on blood pressure and preload
Beta Blockers should not be used in ____ angina
Prinzmetal (vasospastic)
Recommended as alternative or add-on to Beta Blockers in angina
Calcium Channel Blockers
(diltiazem and verapamil) (amlodipine and felodipine)
Nitrates MOA
cause dilation of peripheral arteries and veins through release of nitric oxide in smooth muscle
- decr preload
Nitrates SE
- Headache, hypotension, dizziness, flushing
- Serious: increased intracranial pressure
Nitrates Considerations
- Tolerance limits long-term efficacy
- “Nitrate-free” intervals of 8-10 hours may help
- Contraindicated to use with PDE-5 inhibitors
- Contraindicated in persons with frequent migraine headaches
1st line in acute episodes of angina
Nitroglycerin
Ranolazine MOA
Inhibits Na+ influx which decreases Ca2+ transport via Na/Ca exchange. This decreases ventricular tension and myocardial oxygen consumption. Inhibits K+ channel at higher concentrations
- prolongs action potential duration and QT interval
- no signif effect on HR, BP, preload
Digoxin vs Ranolazine
(-) or (+) inotrope?
Digoxin vs Ranolazine
incr or decr intracellular Na+ & Ca+
Ranolazine SE
dose related
Orthostatic hypotension, peripheral edema, dizziness, headache, GI disturbances, dyspnea, vision changes
when to use
Ranolazine Considerations
- Caution in renal or hepatic impairment
- Many drug interactions (especially CYP3A4)
- Used as add-on therapy for chronic, stable angina
Which HF meds should be avoided in pregnancy?
ACE/ARB/ARNI/Aldo antagonists
Geriatric HF considerations
- More prone to dehydration with loop diuretics
- Higher risk for digoxin toxicity (use lower doses)
Angina Considerations
- *Aspirin, nitrates appear safe
- Labetalol is the preferred beta blocker
- Statins are category X and should be discontinued prior to pregnancy
