CVD- ANGINA + HEART ATTACKS Flashcards
What is coronary artery disease?
Atherosclerosis affects coronary arteries
What are the 2 types of angina?
Stable
Unstable
What are the 2 types of heart attacks?
STEMI
NON- STEMI
What is an acute coronary syndrome?
range of conditions related to sudden, reduced blood flow to the heart
Emergency
What is stable angina?
Ischaemic chest pain caused by exertion or emotional stress
What are the 2 symptoms of angina?
Chest pain
pain radiates to left arm, neck or jaw
Describe angina chest pain?
Tight, dull or heavy
What 4 medications are used in angina?
Short acting nitrate
Long-acting nitrate
BB
Vasodilator
What 2 categories are nitrates split into?
Short acting nitrate
Long-acting nitrate
List 2 short acting nitrates?
GTN
Isosorbide dinitrate
How is GTN administered?
Sublingual
When does GTN expire?
8 weeks
Give 3 examples of long acting nitrates?
GTN - transdermal patch
Isosorbide dinitrate - lasts 12 hrs: BD
Isosorbide mononitrate
What long acting nitrate is a MR preparation take once a morning?
Isosorbide mononitrate
What form of GTN is long acting?
Transdermal
Name 3 vasodilators involved in treating angina?
Ivabradine
Ranolazine
Nicorandil
What is MHRA regarding nicorandil?
Can cause skin, mucosa + eye ulcer
What is 1st line treatment for acute angina attacks?
GTN
How to use GTN during angina?
Use sublingual
Sit down, take 1 dose, repeat every 5 mins
If symptoms don’t go away after 2nd dose. seek medical help
When to call 999 when getting angina?
after 2 doses of GTN - new update 2024
How long does sublingual GTN last?
20- 30 mins
What is 1st line for angina prophylaxis?
Beta blocker
What is an alternative treatment for angina prophylaxis?
Rate limiting CCB
What 2 drugs are used as second line in angina prophylaxis if BB fails?
BB+ CCB
Why do we avoid verapamil and beta blocker?
increased risk of heart failure.
What to give if beta blocker is contraindicated for Angina/ Heart attack?
CCB next
then
Vasodilator dual therapy
What to give if both BB + CCB contraindicated in Angina + heart failure?
Vasodilator monotherapy- e.g. Nitrate, ivabradine, ranolazine, nicorandil
What is the MOA of nitrates?
Potent coronary vasodilator
Reduces venous return and increases cardiac output.
What is a caution of using nitrates?
Tolerance can develop
What 2 types of nitrates can tolerance develop for?
Long acting nitrates
transdermal patches
What 3 things to do if tolerance is developing to nitrates?
- Leave patches off for 8-12 hrs if tolerance detected (GTN).
- Take second dose after 8 hours not 12 hrs
- Take MR isosorbide mononitrate OD
What to do if tolerance detected in MR and conventional tablets of isosorbide?
Take 2nd dose after 8 hours not 12 hrs.
How many times to give MR formulations of isosorbide mononitrate to avoid tolerance?
MR formulations of isosorbide mononitrate should only be given OD.
What are 3 SE of nitrates? (FHP)
Flushing
Throbbing headache
Postural hypOtension
What drug class is known to interact with nitrates to increase hypOtension? (severe)
Phosphodiesterase-type 5 inhibitors (e.g. sildenafil).
What other drug classes can increase hypotension when given with nitrates?
Anti-hypertensives (ACEi, ARB, BB, CCB)