Chapter 51: Drugs for Angina Flashcards
What is stable angina? unstable angina?
Stable angina: chronic type of angina that is triggered by exertion from activity, stress, or consuming a large meal, or exposure to cold.
Unstable angina: This is a medical emergency consisting of severe CAD with vasospasm. Symptoms may present as New exertional ones as well as during periods of rest.
What is the first line of treatment for Angina? What are the different formulations and dosages?
Nitroglycerin, which is available in SL tablets, translingual spray, oral capsules (SR), transdermal patches, IV, and topical ointment.
sublingual: 0.3-0.6 mg prn q5min x 3.
Translingual spray: 1-2 sprays up to 3 sprays w/in 15 min.
Oral capsule (SR): 2.5-6.5 mg 3-4 times/day. Usually given 1-2 times to avoid tolerance.
Transdermal patches: 0.1-0.8 mg/hr. 1 patch per day. remove after 12-14 hrs.
Ointment: 1-2 inches (7.5-40 mg) q 4-6hrs.
IV: 5 mcg/min initially, then increased up to 200 mcg/min.
When should one call 911?
If after the second SL tablet without any improvement
How does nitroglycerin benefit a patient with angina?
This drug decreases the cardiac oxygen demand. It does this by causing vasodilation, which decreases venous return to the heart and decreases ventricular filling. The ventricle walls decrease tension, all decrease oxygen demand.
What are common adverse effects of nitroglycerin?
headache, hypotension, and tachycardia
What are the most serious adverse effects and drug interactions?
Orthostatic hypotension and reflex tachycardia are the most serious.
Drug interactions: antihypertensives, diuretics, beta blockers, calcium channel blockers, and any other hypotensive drugs extra caution needs to be exercised.
what is an acceptable heart rate for someone on beta blocker therapy for angina? What is the acceptable heart rate for someone on beta blocker therapy who does not have angina?
50-60bpm for someone taking a beta blocker to treat acute angina.
Ideally, the bpm for a patient taking beta blockers without angina should not be less than 60 bpm.
What is the dosing schedule for sublingual nitroglycerin in the setting of an acute angina attack?
0.3-0.6 mg SL every five minutes. for a max. of three doses.
What drugs should a patient receive after he has had three SL tablets?
In the ED, the patient may receive aspirin, morphine, a beta blocker, and possibly nitroglycerin IV.
What is tachyphylaxis? and how is this addressed?
Reduced drug effectiveness brought on by repeated dosing over a short period of time.
This is addressed: Patches should be removed every 12-14hrs allowing 10-12 hours of patch free time.
What is Ranolazine? What are its most serious adverse effects? List some drug interactions?
A drug used to treat angina that works by reducing sodium and calcium in myocardial cells.
Serious Adverse effects: QT prolongation, hypertension
Drug interactions: Grapefruit juice, HIV protease inhibitor (ritonavir), macrolide antibiotics: erythromycin, azole antifungals: itraconazole: These RAISE ranolazine levels.
