angina drugs Flashcards
What are the key components in the management of stable angina?
Lifestyle changes, medication, percutaneous coronary intervention, surgery
NICE produced guidelines in 2011 covering these management strategies.
Which medications should all patients with stable angina receive in the absence of contraindications?
Aspirin, statin
These are standard medications for management.
What is used to abort angina attacks?
Sublingual glyceryl trinitrate
This medication provides quick relief during angina episodes.
What does NICE recommend as first-line treatment for stable angina?
Beta-blocker or calcium channel blocker based on comorbidities, contraindications, and patient preference
This approach personalizes treatment based on individual patient factors.
Which type of calcium channel blocker should be used as monotherapy?
Rate-limiting calcium channel blockers such as verapamil or diltiazem
These are preferred for their specific effects on heart rate.
What type of calcium channel blocker should be used in combination with a beta-blocker?
Longer-acting dihydropyridine calcium channel blockers (e.g., amlodipine, modified-release nifedipine)
This combination helps in managing angina symptoms effectively.
What is a critical consideration when prescribing beta-blockers?
They should not be prescribed concurrently with verapamil due to the risk of complete heart block
This is a significant drug interaction to avoid.
What should be done if a patient has a poor response to initial treatment?
Increase medication to the maximum tolerated dose
For example, atenolol can be increased to 100mg once daily.
What should be added if a patient remains symptomatic after monotherapy with a beta-blocker?
Add a calcium channel blocker or vice versa
This step ensures effective symptom management.
If a patient cannot tolerate the addition of a calcium channel blocker or beta-blocker, what alternatives can be considered?
Long-acting nitrate, ivabradine, nicorandil, ranolazine
These alternatives provide options for managing angina without increasing side effects.
When can a third drug be added for patients on both beta-blockers and calcium-channel blockers?
While awaiting assessment for PCI or CABG
This is a strategic approach to manage symptoms during evaluation.
What is nitrate tolerance and how does it affect patients?
Many patients develop tolerance to nitrates, leading to reduced efficacy
This is a common issue in long-term nitrate therapy.
What does NICE advise for patients taking standard-release isosorbide mononitrate to minimize nitrate tolerance?
Use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours
This strategy helps in preserving the effectiveness of nitrates.
What is the exception to the nitrate tolerance effect?
Patients taking once-daily modified-release isosorbide mononitrate
This formulation does not lead to the same tolerance issues.
