Chronic Stable Angina Flashcards
What are the 3 main goals of angina therapy?
- prevent progression to unstable angina, MI or death
- provide relief of anginal sxs
- modify risk factors for CAD
What therapies are used to prevent progression of chronic stable angina?
- anti-platelet therapy
- cholesterol control
What medications are used to provide relief of anginal sxs in chronic stable angina?
- BB
- CCB
- nitrates
How can a pt modify his or her risk factors for CAD?
- exercise and weight control
- BP control
- no smoking
What drug (and dose) should all patients (unless CI) be taking for their chronic stable angina?
-aspirin 75-162 mg per day
What is the goal of anginal pain treatment with BB? (think vital signs)
-target resting HR of 55-60 bpm
What are the cautions for BB use for relief of angina?
- type I DM (BB increase glucose levels)
- asthma (BB cause constriction in lungs)
- decompensated HF
- mod-severe peripheral vascular dz
What are the CIs for BB use for relief of angina?
- bradycardia (HR <50)
- 2nd degree heart block
Which pts might be good candidates for trying a BB first for anginal relief?
-pts with hard indications and NO CI: 6 months post MI or systolic HF (EF <40%)
What should you not do if your pt is on a BB or you are considering a BB?
- do not start BB with HR<55
- do not increase dose with HR at goal
When should CCB dihydropyridines be used for angina relief?
- add to BB if HR < goal
- combine with long-acting nitrates in pts who can’t take BB or non-DHP
When should CCB non-dihydropyridines be used for angina relief?
-HR> goal and a BB would be CI or no hard indication w/ cautions
CCB Adverse Effects
- orthostatic HoTN
- reflex tachycardia
- peripheral edema
CCB CIs
- left ventricular dysfunction
- bradycardia (<50 bpm)
- 2nd or 3rd degree AV block
When should you NOT start a DHP?
- don’t start with >2+ pitting edema
- don’t start with orthostatic HoTN
MOA of Nitrates
- dilates peripheral veins at large doses
- dilates coronary arteries at all doses
- nitrates will not affect BP!
When might long acting nitrates be used?
- long term prophylaxis
- generally added on to other therapies (eg BB or non-DHP to improve sxs control)
- combine with DHP if pt can’t tolerate BB or non-DHP
When might short acting nitrates be used?
- terminate acute anginal attack
- prevention of effort or stress-induced attacks
How should an angina patient respond to chest pain?
- stop activity, sit down, take one NTG
- if pain not improved or worse in 5 mins, take NTG and call 911
- can repeat q5 minutes for total of 3 doses
What is LA Nitrate Tolerance?
-decreases response or increased amount needed for same effect
What is a daily nitrate free interval? When should patients dose? What is the purpose?
- 8-12 hour period of no nitrate meds
- dose at 8 am and 2 pm
- decreases nitrate tolerance
Role of ACE-I in Chronic Stable Angina
- not shown to be effective in reducing angina
- use to reduce morbidity and mortality in pts with HF, DM, CKD, HTN
