Stable angina Flashcards
What is the definition of stable angina?
exertional chest pain relieved by GTN spray
What is the first line management of Angina?
Beta blocker or CCB (rate limiting CCB)
diltiazem or verapamil
What is the second line management?
Beta blocker and dihydropyridine (non rate limiting) CCB
amlodipine, felodipine, lacidipine,
What is the third line management? (4)
Additional therapy of any one of the following; 2x max
1. Long acting nitrate - Isosorbide mononitrate
2. Ivabradine
3. Nicorandil
4. Ranolozine
When should Isosorbide mononitrate be administered? (2)
- should be given 8am and 2pm
- Allow nitrate-free period, avoiding nitrate intolerance
What are the side effects of Isosorbide mononitrate?
SE :
- flushing
- headaches
- hypotension
What is the mechanism of action of Ivabradine?
- Anti anginal drug which acts as a heart rate lowering agent
- inhibits cardiac pacemaker current via If (funny) ion current which is highly expressed in the sinoatrial node
- reducing cardiac pacemaker activity
What should be considered when starting Ivabradine? (2)
- Patient needs to be in normal sinus with resting HR>70bpm
- Should be stopped in 3 months if not working
What are the adverse effects of Ivabradine? (3)
Visual effects, headache, Bradycardia/HB
What is the mechanism of action of Nicorandil?
- Vasodilator
- Activates potassium channels
- causes hyper polarisation
- hence vasodilation of arteries
What are the CI for Nicorandil use? (2)
low BP, LV dysfunction
What is the mechanism of action of Ranolozile?
- Antianginal
- inhibits late sodium channels thus delays action potential and helps heart relax
What are the side effects of Ranolozine use? (2)
- long QT
- avoid in moderate cardiac, renal and liver failure
