Anti-anginal Agents

Question 1

What is angina?

Answer 1

A condition resulting from insufficient oxygenation of myocardium. It may be due to vasospasm in coronary arteries, or atherosclerosis. Can occur at rest or during activity.

Question 2

What are anti-anginal agents aimed to do?

Answer 2

Relax smooth muscle of the coronary arteries, thus reducing workload of the heart and dilating blood vessels to increase blood supply. This may include the use of vasodilators.

Question 3

Name two vasodilators.

Answer 3

• nitrates
• beta blockers
• calcium channel blockers

Question 4

Explain the difference between fast acting and slow acting nitrates.

Answer 4

Fast acting nitrates
- treat acute angina attacks

Slow acting nitrates
- used to prevent anginal attacks from occurring

Question 5

Explain the action of nitrates.

Answer 5

• relax smooth muscle causing vasodilation
• decrease myocardial oxygen demand by reducing preload and after load
• reduce blood pressure
• readily absorbed through buccal mucosa (under tongue), nasal mucosa and skin

Question 6

Name two common nitrates.

Answer 6

• glyceryl trinitrate (GTN)
• isosorbide mononitrate
• isosorbide dinitrate

Question 7

Name five care considerations on nitrates.

Answer 7

• monitor vital signs closely
• patient education paramount, especially if taking with anginine
• take as early as possible, sitting down for 10-20 minutes after
• keep tablets cool, dry and out of sunlight
• label bottle on opening and discard remaining tablets after 3 months
• no sudden position changes (may cause orthostatic hypotension)
• careful handling of GTN preparations as these can be absorbed through the skin

Question 8

What should we consider when taking nitrates during an attack?

Answer 8

• if treated early in an attack, half a tablet may relieve pain
• allow the tablet to dissolve under the tongue
• the tablet can be removed or swallowed if pain ceases or headache is severe
• if two more tablets do not relieve pain in 15 minutes, you must call an ambulance

Question 9

GTN can be absorbed through the skin. True or False.

Answer 9

True. This is why we must be careful handling GTN during preparations.

Question 10

Name at least one other type of drug that can be used to treat angina and explain.

Answer 10

Beta adrenergic blockers
- indicated for long term management of angina pectoris caused by atherosclerosis

Calcium channel blockers
- used for variant angina, chronic angina, effort associated angina and hypertension

Verapamil
- used to treat cardiac tachyarrhythmias because it slows cardiac conduction

Question 11

What is the drug of choice to treat an angina episode?

Answer 11

GTN