Angina And MI Flashcards
Rationale for treatment of angina
Increase O2 supply by vasodilation with nitrates and CCBs
Decrease O2 demand with beta blockers and CCBs
1st line for typical angina
Beta blockers
Cardioselective beta blockers
Metoprolol
Atenolol
Nebivolol
Non selective beta blockers
Propranolol
Nadolol
Alpha and beta blockers
Carvedilol
Labetalol
Initial therapy for angina if beta blockers are contraindicated
Non-DHP CCBs
CCBs preferred for variant angina
Non DHPs
Add on therapy to beta blockers
DHP CCBs
DHP CCBs used in angina
Amlodipine
Felodipine
Nifedipine
MOA for organic nitrates
Release NO that diffuses into vascular smooth muscle and dilates veins to decrease preload and ventricular pressure to decrease myocardial O2 demand
CI for nitrates
Aortic valve stenosis, use of Viagara, Levitra, Cialis; angle closure glaucoma, head trauma, cerebral hemorrhage, anemia, severe hypotension
ADRs of nitrates
H/a dizzy weakness postural hypotension rash anxiety
TOLERANCE
Monitoring parameters for nitrates
BP
HR
Role of nitrates in managing angina
SL to relieve acute symptoms of myocardial ischemia
SL/PO to prophylax effort induced angina
Long acting formulas for maintenance if beta blockers and CCBs contraindicated
Nitrate formulations
Amyl nitrate- rapid onset, used for cyanide poisoning
Nitroglycerin - SL ointment patch IV or PO
Isosorbide- dinitrate and mononitrate forms
Ranolazine uses
Chronic stable angina as add on to CCB beta blocker or nitrate
MOA ranolazine
Sodium current inhibitor
CI for ranolazine
Prolonged QT
Hypokalemia
Hepatic failure
CYP 3a4 inhibitors
Adjunct therapy to prevent ACS in patients with unstable angina
Aspirin
Other anti platelet treatments for angina
Clopidogrel
Prasugrel
Ticagrelor
Used in patients with CAD to prevent dz progression but do not relieve angina directly
ACE inhibitors
How to treat predictable episodes of angina caused by exertion
Nitroglycerin or isosorbide
Frequent episodes of angina should be treated with
Nitroglycerin beta blocker CCB or nitrate
How to treat angina in asthma patient
Non DHP CCB or cardioselective beta blocker
How to treat angina in DM patient
Non DHP CCB most preferred also nitrates and cardioselective beta blockers
How to treat angina in heart failure patients
beta blockers and nitrates most preferred
How to treat angina in HTN patient
Beta blocker and non DHP CCB
How to treat angina in patient with prior MI
Beta blockers
How to treat angina in patient with bradycardia or heart block
DHP CCB preferred
Drugs for acute STEMI
Aspirin- all patients, start asap and continue forever
IV nitroglycerin - for first day or two, not if hypotension or bradycardia
Analgesics- morphine decreases pain and increases reperfusion
Beta blockers- start asap and continue post MI to reduce magnitude of infarction and rate of reinfarction
ACE inhibitors- post MI if left ventricle dysfxn or CHF
CCBs- controversial, can be given if intolerant to beta blockers
Anticoagulants- heparin, bivalrudin, fondaparinux
P2Y inhibitors- clopidogrel, pasugrel or Ticagrelor
Fibrinolytics- dissolve clots ex streptokinase, alteplase, reteplase, anistreplase, tenecteplase
Statins
If CABG indicated what do you do with anti platelet drugs
Hold for 5-7 days
Are fibrinolytics used in Non-STEMI patients
No, only STEMI patients
Variant angina is caused by
Acute coronary vasospasm
