Angina and Ischemia

Question 1

Nitroglycerine

Answer 1

Potent vasodilator
CONTRA: concurrent use with PDE-5 inhibitors (-afil’s) can cause life threatening hypotension
ADR: headache, dizzy, hypotension, reflex tachy

Question 2

Beta Blockers

Answer 2

On a fixed schedule, provide sustained protection against effort induced angina pain
Increase exercise tolerance and decrease frequency/severity of angina pain
Decrease cardiac O2 demand by decreasing HR and contractility
Follow selective vs. non-selective guidelines

Question 3

CCB

Answer 3

Verapamil and diltiazem
When BB are CONTRA or lack response
Decrease PV resistance and HR and contractility
Increase O2 supply and decrease demand

Question 4

Ranolazine

Answer 4

Chronic angina
Reduce ventricular tension & O2 consumption
CONTRA: hepatic cirrhosis, cocommitant use with strong CYP 3A4 inhibitors or inducers
ADR: QT prolongation and HTN in CKD pts

Question 5

Approach to therapy

Answer 5

ASA
ACE
STATIN
BB/CCB
Ranolazine
long acting nitrate
smoking cessation