Ischaemic heart disease Flashcards
What comprises the management of stable angina?
The management of stable angina comprises lifestyle changes, medication, percutaneous coronary intervention, and surgery.
What medications should all patients with stable angina receive?
All patients should receive aspirin and a statin in the absence of any contraindication.
What is the purpose of sublingual glyceryl trinitrate?
Sublingual glyceryl trinitrate is used to abort angina attacks.
What does NICE recommend as first-line treatment for stable angina?
NICE recommends using either a beta-blocker or a calcium channel blocker first-line based on comorbidities, contraindications, and the person’s preference.
What type of calcium channel blocker should be used as monotherapy?
If a calcium channel blocker is used as monotherapy, a rate-limiting one such as verapamil or diltiazem should be used.
What should be used if a calcium channel blocker is combined with a beta-blocker?
A longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine) should be used.
What is a contraindication for prescribing beta-blockers?
Beta-blockers should not be prescribed concurrently with verapamil due to the risk of complete heart block.
What should be done if there is a poor response to initial treatment?
Medication should be increased to the maximum tolerated dose (e.g. for atenolol 100mg od).
What to do if a patient is still symptomatic after monotherapy?
If a patient is still symptomatic after monotherapy with a beta-blocker, add a calcium channel blocker and vice versa.
What alternatives can be considered if a patient cannot tolerate the addition of a calcium channel blocker or a beta-blocker?
Consider one of the following drugs: a long-acting nitrate, ivabradine, nicorandil, or ranolazine.
When should a third drug be added for patients on both a beta-blocker and a calcium-channel blocker?
Only add a third drug while a patient is awaiting assessment for PCI or CABG.
What is a common issue with patients taking nitrates?
Many patients who take nitrates develop tolerance and experience reduced efficacy.
What does NICE advise for patients taking standard-release isosorbide mononitrate?
NICE advises using an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimize the development of nitrate tolerance.
What is the exception regarding nitrate tolerance in modified-release isosorbide mononitrate?
This effect is not seen in patients who take once-daily modified-release isosorbide mononitrate.
