CARDIO: NICORANDIL

Question 1

NICORANDIL: INDICATIONS

Answer 1

• Prevention and Tx of patients with Stable Angina (additional if the beta blockers and CCBs are insufficient)

Question 2

NICORANDIL: MOA

Answer 2

• Actions as a Nitrate and by activating K+-ATP channels
• Efflux of K+ through activated K+-ATP channels leads to hyperpolarisation of the cell membrane and subsequent inactivation of voltage gated Ca2+ channels
• The net effect is a decrease in intracellular calcium
• As calcium is required for smooth muscle contraction, vasodilatation and relaxation occurs -> reduce csrdiac preload and systemic and coronary vascular resistance
• Improves myocardial perfusion and decreases myocardial work and oxygen demand
• Clinically reduces the frequency and severity of angina attacks

Question 3

NICORANDIL: ADVERSE EFFECTS

Answer 3

• Flushing
• Dizziness
• Headache
• Nausea, vomiting and hypotension
• GI, skin or mucosal ulceration

Question 4

NICORANDIL: WARNINGS

Answer 4

• Poor LVFxn
• Hypotension
• Pulmonary Oedema

Question 5

NICORANDIL: INTERACTIONS

Answer 5

Hypotensive side effects are enhanced by phosphodiesterase inhibitors (eg sildenafil)