Angina

Question 1

Most common cause of angina

Answer 1

Coronary occlusion due to atherosclerosis

Question 2

Angina Classification

predictable and reproducible. Relieved by rest or nitroglycerin

Answer 2

Stable Angina

Question 3

Angina classification

angina at rest (usually lasting more than 20 min), new onset angina, or increasing angina

Answer 3

Unstable Angina

Suggestive of acute coronary syndrome without troponin elevation

Question 4

Angina classification

angina at rest relieved by nitroglycerin

Answer 4

Vasospastic (Prinzmetal) Angina

Question 5

Non-pharm trmnt of Angina

Answer 5

Diet
Exercise
Smoking cessation
HTN management
Medical procedures

Question 6

Pharm trmnts of Angina

Answer 6

Aspirin (low-dose)
Statin

Question 7

Anti-anginal agents

Answer 7

Beta Blockers
Calcium Channel Blockers (CCBs)
Nitroglycerin
Isosorbide mono/dinitrate
Ranolazine

Question 8

1st line agent for Angina

Answer 8

Beta Blockers
- Reduce heart rate and contractility
- Minimal effect on blood pressure and preload

Question 9

Beta Blockers should not be used in ____ angina

Answer 9

Prinzmetal (vasospastic)

Question 10

Recommended as alternative or add-on to Beta Blockers in angina

Answer 10

Calcium Channel Blockers
(diltiazem and verapamil) (amlodipine and felodipine)

Question 11

Nitrates MOA

Answer 11

cause dilation of peripheral arteries and veins through release of nitric oxide in smooth muscle
- decr preload

Question 12

Nitrates SE

Answer 12

• Headache, hypotension, dizziness, flushing
• Serious: increased intracranial pressure

Question 13

Nitrates Considerations

Answer 13

• 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

Question 14

1st line in acute episodes of angina

Answer 14

Nitroglycerin

Question 15

Ranolazine MOA

Answer 15

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

Question 16

Digoxin vs Ranolazine

(-) or (+) inotrope?

Answer 16

Question 17

Digoxin vs Ranolazine

incr or decr intracellular Na+ & Ca+

Answer 17

Question 18

Ranolazine SE

dose related

Answer 18

Orthostatic hypotension, peripheral edema, dizziness, headache, GI disturbances, dyspnea, vision changes

Question 19

when to use

Ranolazine Considerations

Answer 19

• Caution in renal or hepatic impairment
• Many drug interactions (especially CYP3A4)
• Used as add-on therapy for chronic, stable angina

Question 20

Which HF meds should be avoided in pregnancy?

Answer 20

ACE/ARB/ARNI/Aldo antagonists

Question 21

Geriatric HF considerations

Answer 21

• More prone to dehydration with loop diuretics
• Higher risk for digoxin toxicity (use lower doses)

Question 22

Angina Considerations

Answer 22

• *Aspirin, nitrates appear safe
• Labetalol is the preferred beta blocker
• Statins are category X and should be discontinued prior to pregnancy