Treatment of stable angina Flashcards
For relief of symptoms
- Beta blockers
- Calcium channel blockers
- Nitrovasodilators
- Ivabridine
- Nicorandil
How do Beta blockers work?
- Reduce Heart rate
- Reduce contractility
- Reduce systolic BP
- Increase perfusion to sub endothelium and therefore diastolic blood perfusion
- Protect myocytes from 02 free radicals
Therefore increase the threshold for angina
What is rebound phenomena?
When HR is decreased too quickly due to drugs being administered too quickly
- men over 50
- patients with angina
ADRs for beta blockers
- bradycardia
- impotence
- fatigue
- bronchospasm
Contraindications for beta blockers?
- asthma
- PVD
- Heart failure
- Bradycardia
main beta blocker?
Atenolol
drug-drug interactions for beta blockers?
primary pharmacodynamic:
-hypotension when used with other hypotensive drugs
-bradycardia when used with other rate limiting drugs
-cardiac failure when used with inotropic drugs
Can mask the effect of hypoglycaemic drugs such as insulin
How do calcium channel blockers work?
Block the L-type calcium channels
This prevents influx of calcium and therefore decrease contractility
Rate limiting: decrease HR
vasodilating
What are the ADRs for CCBs
- ankle oedema
- flushing
- headache
- palpitations
Contraindications for CCBs
- MI
- Bradycardia
- Never use immediate release-NIFEDIPINE
how do Nitrovasodilators work?
They release NO- triggers release of cGMP
This cause smooth muscle to dilate and therefore lead to relaxation
Reduces after load and preload which decreases 02 demand
Reduce afterload- arteriolar dilation
Reduces preload- reduces venous return by causing peripheral venodilation
Redistributes blood flow to ischaemic areas
ADRs for nitrovasodilators
- hypotension
- headaches
Different types of nitrovasodilators
long-acting
short-acting
-GTN spray: sublingual to avoid first-pass metabolism
-Oral nitrates: given once a day- prophylactic
-IV nitrates
How Does Ivabridine work?
A selective L-type calcium channel inhibitor
Slows down HR and Sinoatrial node of depolarisation
How does Nicorandil work?
- Preconditioning agent
- Activates ATP sensitive K+ channels: K+ efflux and hyper polarisation of smooth muscle of heart wall
- Leads to closure of Ca 2+ channels - Relaxation of smooth muscle and vasodilation of arterioles
Has a negative inotrophic effect so decreases contractility
Drugs which slow down progression of disease?
- ACE inhibitors
- statins
- asprin
Aspirin/clopidogrel
75-100mg
protect lining of endothelium
Reduce platelet thromboxane production
most common cause of GI bleeds
ACE inhibitors
Reduce platelet rupture and stabilise atheromas
statins
reduce the deposition of LDLs into atheromas
Treatment plan
- beta blockers
- rate limiting CCBs
- vasodilating CCBs
- ivabradine
- aspirin
- statins
- nitrovasodilators
- nicorandil
Ranolazine
- prevents late inward flow of sodium into the heart muscle
- this reduces calcium influx
- reduces contractility- reduced o2 requirements
