Chapter 45: Angina Pectoris

Question 1

Drugs to tx angina

Answer 1

Nitroglycerine
Beta Blocker
Calcium Channel Blockers
Isorbide Mononitrate (or dinitrate)
Ranolazine (Ranexa)

Used to treat angina pectoris
Used in CAD to prevent angina
Angina may lead to myocardial infarction (MI)

First on try lifestyle changes
Medications increase O2 supply by vasodilating coronary arteries

Question 2

Types of angina

Answer 2

Stable-Occurs with predictable
stress or exertion
relieve by nitro or rest

Unstable- Unpredictable regarding stress/exertion and intensity
-Not relieved by rest or nitro

Variant (Prinzmetal’s)- Vasospasm
Causes: coke, inherited
Tx: CCB

Question 3

Nitro

Answer 3

Drug of choice fr acute angina

Question 4

Nitro MOA

Answer 4

Stimulates vascular smooth muscle relaxation resulting in vasodilation. Decreases the pain of angina by decreasing the cardiac O2 demand.

Pretty much works on VV no AA –vasodilation on smooth mm in VV indirectly affects smooth mm in arteries -> more O2 getting to myocardium

Question 5

Nitro uses

Answer 5

Rapid onset: termination of an ongoing attack and short term prophylaxis before anticipated exertion.

Question 6

Nitro SE

Answer 6

Headache, orthostatic hypotension, reflex tachycardia

Reflex tachycardia if someone takes to much nitro they can build up tolerance and have tachy
HA will diminish after they use to and their body wont respond as dramatically. Tx HA with NSAIDS or ASA

Can reverse tolerance by holding nitro for short time
Nitro patch: on for 12 hr, off for 12 hr

D/c slowly to prevent reflex tachy

Question 7

Nitro forms

Answer 7

SL tablets, Translingual spray, transdermal patches, topical ointment
Watch interactions with antihypertensives.
Overuse can lead to tolerance.

Question 8

Nitro stat SL tablets

Answer 8

Rapid Onset

Should not be chewed, crushed, or swallowed.
They work much faster when absorbed through the lining of the mouth.

Usually give relief in 1 to 5 minutes.
May take 0.3-0.6 mg as needed for a total of 3 doses in 15 min,
If CP persists after 3 doses, Call 911.***

Storage
Keep out of the reach of children.
Sublingual tablets should be kept in the original glass bottle with screw cap.
store the bottle at room temperature, away from heat, moisture, and direct light.

Expires every 6 month.

A tingling feeling under the tongue means it is working.

Question 9

Nitro prescribing considerations: therapeutic goals

Answer 9

Reduction of the frequency and intensity of attacks

Question 10

Prescribing considerations: baseline data

Answer 10

Note frequency and intensity of attacks. BP and HR should be noted

Question 11

Prescribing consideration: monitoring

Answer 11

No routine blood monitoring necessary

Question 12

Prescribing considerations: identifying high risk patients

Answer 12

Use with caution in hypotensive patients and in patients taking drugs that lower BP

Question 13

Prescribing considerations: evaluating therapeutic effects

Answer 13

Instruct patients to keep a record of frequency and intensity of attacks and factors that precipitate these attacks

Question 14

Nitro: min ADR

Answer 14

Use with phosphodiesterase type 5 inhibitors is contraindicated:
avanafil (Stendra®),
sildenafil (Viagra®),
tadalafil (Cialis®),
vardenafil (Levitra®)

Using these medicines together may cause hypotension (blurred vision, dizziness, lightheadedness, or fainting).

If patient is taking these medicines and have an angina attack, they must be instructed to go to the ER right away.

Question 15

Isorbide Mononitrate and Isorbide Dinitrate trade names

Answer 15

Imdur, Isordil

Question 16

Isorbide Mononitrate and Isorbide Dinitrate MOA

Answer 16

Same as nitro

Question 17

Isorbide Mononitrate and Isorbide Dinitrate uses

Answer 17

Angina

Question 18

Isorbide Mononitrate and Isorbide Dinitrate route

Answer 18

PO

Question 19

Isorbide Mononitrate and Isorbide Dinitrate SE

Answer 19

HA, hypotension, and reflux tachycardia

Question 20

Isorbide Mononitrate and Isorbide Dinitrate dosage

Answer 20

Taken regularly for sustained prophylaxis. Due to tolerance, the dosing preparations should allow at least 12 hour drug free hours a day.

Question 21

Ranolazine (Ranexa) MOA

Answer 21

Exact mechanism is unknown however, Reduces accumulation of sodium and calcium in myocardial cells

Newer class of anti anginals

Question 22

Ranolazine use

Answer 22

1st like for angina

Question 23

Ranolazine SE

Answer 23

QT Prolongation, elevation of BP

Question 24

Ranolazine safety/monitoring

Answer 24

Avoid grapefruit juice

Question 25

Other drugs Ranolazine is often given with

Answer 25

Drugs used to prevent MI and Death
Antiplatelet Drugs
Cholesterol lowering Drugs
ACE i