Treatment of Angina

Question 1

1st line

Answer 1

BB +/- calcium channel blockers

Question 2

What BB are used?

Answer 2

Atenolol 50mg BD

Bisoprolol 5-10mg OD

Question 3

What calcium channel antagonists are used?

Answer 3

Amlodipine 5mg OD

Diltiazem

Question 4

Long acting nitrates

Answer 4

Isosorbide mononitrate

alternative of GTN skin patches

Question 5

What are side effects of long acting nitrates?

Answer 5

Headaches

hypotension

Question 6

What is used for symptomatic relief in Angina

Answer 6

GTN

SE of headaches and hypotension

Question 7

Ivabradine

Answer 7

Reduces HR with minimal impact on BP

Pt must be in sinus rhythm

5mg BD or 2.5mg in elderly

Question 8

Ranolazine

Answer 8

Inhibits late Na+ current

Start at 375mg BD

Question 9

When should Ranolazine be used with caution?

Answer 9

Heart failure
Elderly
Weight <60kg
Prolonged QT interval

Question 10

Nicorandil

Answer 10

K+ channel activator

5-10mg BD

Question 11

When is Nicorandil contraindicated?

Answer 11

Acute pulmonary oedema
Severe hypotension
Hypovolaemia
LV failure