Angina Flashcards
Overall aim of pharmacological treatments for angina
To restore the imbalance between myocardial oxygen supply and demand.
In an early AMI, pharmacological treatment is used to
Restore myocardial oxygen supply
Most medicines given for the chronic management of CHD reduce
Myocardial oxygen demand
In acute care settings, oxygen is administered and titrated to
Augment PaO2 and SaO2 and optimise oxygen delivery to the myocardium (GTN, aspirin, morphine)
The top ten treatment elements for angina include:
Aspirin and anti-anginas therapy; beta-adrenergic blocker and blood pressure (ACEI); cigarette smoking and cholesterols diet and diabetes; education and exercise
Aspirin is used for
Prophylaxis
Aspirin doses
75-150mg per day
Aspirin works by
Inhibiting platelet aggregation by irreversibly inhibiting cyclo-oxygenase reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation)
AEs of aspirin
GI irritation, asymptomatic blood loss and increased bleeding time
Anti-anginal therapy includes
GTN, isosorbide dinitrate and isosorbide mononitrate
Anti-anginal: dosage for sublingual tablets
300-600mcg every 3-4 minutes, until pain is resolved to a max of 1800mcg- if no relief, call help/ambulance
Anti-anginal: dosage for lingual aerosol
400-800mcg, repeat after 5 mins. If necessary, to a max of 3 sprays
Anti-anginal: use for transdermal patch
For sustained release; angina prophylaxis
AEs of anti-anginals
Dizziness, headache, hypotension, flushing, tachycardia, palpitations, orthostatic hypotension, fainting and peripheral oedema.
Concurrent alcohol use may also enhance orthostatic hypotension
Cardio-selective beta blockers can
Reduce frequency of angina and prolong exercise capacity as well as decrease the risk of adverse cardiac events and mortality
E.g. of cardio-selective beta-blockers
Atenolol (25-100mg/day) and metoprolol (50-300mg/day)
How do cardio-selective beta-blockers work
By competitively blocking beta-receptors in the heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver
What do cardio-selective beta-blockers do
Decreases HR, alter conduction velocity, myocardial contractility and decrease CO
Common AEs of cardio-selective beta-blockers
Bradycardia, hypotension, orthostatic hypotension, transient worsening of heart failure, nausea, diarrhoea, bronchospasm, dyspnoea, cold extremities, exacerbation of Raynaud’s phenomenon, fatigue, dizziness, abnormal vision, alteration of glucose and lipid metabolism
BP controlled with
ACE inhibitors/second generation AT1 receptor blockers prevent remodelling and reduce mortality following an AMI
E.g. of ACE inhibitors
Captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril
What do ACE inhibitors do
They block conversion of angiotensin I to angiotensin II and inhibit the breakdown of bradykinin. Reduce vasoconstriction, sodium retention and aldosterone release
AEs of ACEI
Hypotension, headache, dizziness, cough, hyperkalaemia, fatigue, nausea and renal impairment
Cigarette smoking treatment
Can be used in conjunction with nicotine replacement therapy and other treatments.
5As framework for smoking cessation- well recognised behavioural strategy for addiction.
Treatment for cholesterol
Stains are the first line in lipid-lowering treatment (apart from diet) for the reduction of CVD risk
E.g. of statins
Atorvastatin, rosuvastatin, simvastatin
Diet and diabetes treatment
Reduce intake of saturated and trans fats.
Replace saturated fats with monounsaturated and polyunsaturated fats, increasing intake of soluble fibre.
Introduce plant sterol and enriched milk, margarine or cheese products.
The most effective dietary measure and can reduce LDL-C.
Excess body weight is associated with many major risk factors for CVD including T2DM, elevated BP and dyslipidaemia.
Implementing education and exercise
Regular physical activity has a beneficial effect on multiple CV risk factors as well as a significant mortality benefit.
Should be strongly encouraged in patients, for both prevention and management of CV disease.
