CV: Stable Angina

Question 1

If angina attacks more regularly than __________, regular drug therapy is required and should be introduced in a step-wise manner according to response.

Answer 1

If more than twice weekly.

Question 2

Patients with stable angina who require regular drug treatment should be given what? (2)

Answer 2

Either BB or CCB.

Question 3

For patients with stable angina in whom either a BB or CCB alone fails to control symptoms, what can be done?

Answer 3

If a beta-blocker or a calcium-channel blocker alone fails to control symptoms adequately, a combination of a beta-blocker and a dihydropyridine calcium-channel blocker (e.g. amlodipine, felodipine, modified-release nifedipine) should be used; if this combination is not appropriate due to intolerance of, or contra-indication to, either beta-blockers or calcium-channel blockers, addition of a long-acting nitrate, ivabradine, nicorandil, or ranolazine can be considered.

Question 4

For patients with stable angina who the combination of a CCB + BB is not appropriate, what can be added to treatment?

Answer 4

A long-acting nitrate
OR
Ivabradine (If ion channel)
OR 
Nicorandil (K channel activation: stimulates guanylate cyclase to increase formation of cGMP)
OR 
Ranolazine (sodium channel inhibitor)