Stable Angina Flashcards
What is stable angina?
Predictable chest pain or pressure due to physical exertion or emotional
Initial treatment of stable angina
Glyceryl trinitrate (sublingual) - dose to be taken at 5 minutes intervals
Can be prophylactically or when symptoms arise
When would stable angina be considered a medical emergency?
When symptoms haven’t resolved after the third dose of GTN spray
Long-term prevention of stable angina
1st line: beta blocker (RL-CCB if Beta blocker contraindicated)
2nd line: beta blocker + CCB (amlodipine, lacidipine, etc) never RL-CCB + BB
3rd line: long-acting nitrate = nicorandil, ivabradine, or ranolazine
- Monotherapy for those who can’t tolerate BB or CCB
Life-style measures and introduce 75mg aspirin and low dose statin e.g., 20mg atorvastatin
- Response to treatment should be assessed every 2-4 weeks following initiation or change of drug therapy; titrated to max tolerated dose
Specific side effect of nicorandil
GI and mucosal ulceration
When should GTN sublingual tablets be discarded?
8 weeks after opening
Why should patients have a nitrate free period?
Prevent tolerance
How should nitrates be taken?
8 hours apart to provide nitrate free window
How many hours should a nitrate patch be taken off during a day?
8-12 hours
Side effects of nitrates
Dizziness
Flushing
Headaches
When should nitrates be prescribed in caution and why?
In the elderly due to risk of falls and fragility
Duration of action of sublingual GTN
20 to 30 minutes
Treatment and prophylaxis of angina
Isosorbide dinitrate (treat and proph)
Isosorbide mononitrate (proph)
Which nitrates are licensed for use in the treatment of heart failure? Route?
GTN
Isosorbide dinitrate
IV
