Anti-anginal drugs Flashcards
What are the two anti-anginal drugs?
Nitrates and CCB’s
How do nitrates work?
vasodilatory effect - they improve cardiac output so good in HF
What are nitrate S/E?
Flushing, headaches, postural hypotension
If a patient has angina, what nitrate would they take? Explain its properties.
sublingual GTN (glyceryl trinitrate - comes in patches or spray). It provides rapid symptomatic relief of an angina attack and can last 20-30 minutes. They expire 8 weeks from opening.
What is isosorbide mononitrate?
can come in M/R preparations. Normally m/r lasts up to 12 hours between the first dose and the second dose
But with ISMN - must maintain a nitrate-free period to prevent tolerance (second dose should be given 8 hours after first and no later than 6pm)
What are CCB’s? How do they work?
Amlodipine, diltiazem, felodipine
Reduce myocardial contraction
What are the S/E of CCB’s?
Flushing, headaches
Patients newly prescribed to CCB’s get swelling of the ankles
verapamil - constipation
What’s important with patients on diltiazem and verapamil?
Patients must stick to the same brand
Diltiazem (Tildiem Retard, Adalat Retard) - tablet membrane may pass the GI tract unchanged, but being porous has no effect on efficacy
What occurs with sudden withdrawal?
can be associated with exacerbation of angina
What are other CCB’s?
Ivabradine (lowers HR)
Nicorandil - ulceration is a big S/E - used in the prevention and longterm tx of angina - driving is not affected in patients on this (this is a K+ channel activator with nitrate component)
Ranolazine - Used as adjunctive therapy in pts that are intolerant and inadequately controlled.
what are sympathomimetics?
Can be affecting alpha or beta adrenergic receptors.
Adrenaline acts on both - increases heartrate and contractility (BETA-1 effect)
Causes peripheral dilation (BETA-2 effefct)
Cause vasoconstriction (alpha effect)
What are ionotropic sympathomimetics?
adrenaline
What are vasoconstrictor sympathomimetics?
Noradrenaline
