Chapter 54: Drugs for Angina Pectoris Flashcards
What is angina pectoris
- sudden pain beneath the sternum, often radiating to the left shoulder and arm
- oxygen supply to the heart is insufficent to meet oxygen demand
what are the 2 goals of angina drug therapy
- prevention of myocardial infraction and death
- prevention of myocardial ischemia and anginal pain
what are angina triggers
4 E
- eating a large meal
- exercise and other physical activity
- emotions
- extreme cold weather
treatment strategy of chronic stable angina (exertional)
- increase cardiac oxygen supply
- decrease oxygen demand
Chronic stable angina therapeutic agents
- Organic nitrates (Nitroglycerin)
- beta blockers (Metoprolol and propranolol
- calcium channel blockers (verapamil or nifedipine)
- Atrial- selective sodium channel blocker (ranolazine)
Chronic stable angina (exertional) nondrug therapy treatment
- avoid factors (overexertion, heavy meals, stress, exposure to cold)
- decrease risk factors (smoking, hyperlipidema, hypertension, sedentary lifestyle)
what is variant Angina (prinzmetal)
coronary artery spasm which restricts blood flow
Variant Angina treatment strategy
- reduce severity and incidence of attacks
- increase cardiac oxygen supply
variant angina therapeutic agents
- calcium channel blockers
- organic nitrates
varient angina often occurs
during rest
what is unstable angina
- severe CAD complicated by vasospasm, platelet aggregation, transient coronary emboli
what are the symptoms of unstable angina
- angina at rest
- new onset exertional angina
- intensification of existing angina
unstable angina treatment strategy
- maintain oxygen supply
- decrease oxygen demand
therapeutic agents for unstable angina
- anti-ischemic therapy
- antiplatelet therapy
- anticoagulant therapy
nitroglycerin dose
- three doses sublingually every 5 mins (tablet or spray), followed by IV therapy if perisitant ischemia or hypertension occurs
beta blockers does
give first dose IV if chest pain is ongoing
Acetylsalicylic acid should be used
indefinitely
Acetylsalicylic acid examples
Aspirin
- Clopidogrel [Plavix]
- Ticlopidine [Ticlid]
Anticoagulant therapy examples
- subcutaneous LMW heparin
- direct thrombin inhibitors
- factors Xa inhibitors
- IV unfractionated heparin
Nitroglycerin [Nitrospray] MOA
acts directs on vascular smooth muscle to promtote vasodialtion (primarily in the veins)
Nitroglycerin [Nitrospray] is used for
stable and variant angina
Nitroglycerin [Nitrospray] pharmacokinetics
- t1/2: 5-7 mins
- large first pass effect
Nitroglycerin [Nitrospray] adverse effects
- headache (severe but diminishes over time)
- orthostatic hypotension
- reflex tachycardia
Nitroglycerin drug interactions
- hypotensive drugs
- Phosphodiesterase type 5 inhibitors (sildenafil [viagra])
nitroglycerin negative effect
tolerance
nitroglycerin translingual spray
- prime before use
nitroglycerin transdermal delivery systems
every 12 hours
nitroglycerin IV infusion
- slow infusion rate intially, continuous CV monitoring, diluted before administration, dont mix with other drugs
nitroglycerin long acting preperations examples
- Isosorbide dinitrate [Isordil]
- Isosorbide monitrate
Nitroglycerin long acting preperations therapeutic uses
- long tern prophylaxis
long acting preperations adverse effects
headache, hypotension, and reflex tachycardia
beta blockers examples
- propranolol
- metoprolol
beta blockers adverse effects
- bradycardia
- decreased atriventricular (AV) conduction
- reduction of contractility
- asthmatic effects
- insomnia
- depression
beta blockers should be used in caution in patients with
diabetes
calcium channel blockers examples
- verapamil
- diltiazem
- nifedipine
calcium channel blockers are used for
stable and variant angina
calcium channel blockers adverse effect
- dilation of peripheral arterioles leads to reflex tachycardia
late sodium current inhibitor example
ranolazine [corzyna]
Icosapent Ethyl [Vascepa] effects on ECG
causes QT prolongation
Icosapent Ethyl [Vascepa] side effects
dizziness, headache, constipation, nasuea
Icosapent Ethyl [Vascepa] contradictions
- concurrent use with strong CYP P450 3A4 drugs
- severe renal or hepatic impairment
Icosapent Ethyl [Vascepa] dose
BID,
** do not crush
other drugs used for angina pectoris
- antiplatelets
- antihyperlipidemics
- ACEI
initial therapy of variant angina
calcium channel blockers or long acting nitrate
what is not effective with vasospastic angina
beta blockers
