Pharmacology - Antianginal

What is the DOC for relief from acute angina attacks?

Nitrates

Nitrate MOA

Relax smooth muscle in vasculature (esp veins) and decreasing coronary vasoconstriction or spasm

Do beta blockers increase oxygen delivery?

No

Do beta blockers decrease oxygen demand?

Yes

Can you use beta blockers with variant (Prinzmetal) angina?

No

Why can't you use beta blockers for variant angina?

blocking b2 vasodilation allows possible UNOPPOSED alpha 1 vasoconstriction

How might you manage patients with chronic stable angina to prevent future attacks?

beta blocker, CCB, and long lasting nitrate

How might you manage patients with chronic unstable angina to prevent future attacks?

beta blocker, CCB, long lasting nitrate, and ASA or Plavix if ASA can't be tolerated

What do you take for acute angina pain?

Morphine

Nitrate Adverse Rxns

HAFlushingHOTNReflex Tachy

How do you overcome the reflex tachy side effect of nitrate?

Take a beta blocker or CCB

Why must you have a nitrate-free period of 8 to 12 hours per day?

Because tolerance to nitrates develops quickly

What instruction would you give your patient taking SL nitrate (nitrostat)?

Take 1 tablet SL PRN for an angina attack. Be sure to sit down when taking the tablet.If pain has not stopped, take another every 5 minutes. Max dose is 3 tablets. If pain has not stopped after taking 3 tablets, go to ER.

What type of drugs will cause severe HOTN when combined with nitrates?

phosphodiesterase-V inhibitors (Viagra, Levitra, Cialis)

What is the bioavailability of Isosorbide dinitrate and mononitrate?

almost 100%

Can you use beta blockers with ISA for angina?

No

Name the beta 1 blockers approved for angina?

Tenormin and Lopressor

Name the nonselective beta blockers approved for angina.

Propranolol and Nadolol

Which is the only CCB that you can safely use in HF?

Amlodipine

Which CCBs are the preferred ones in angina treatment?

Verapamil and Diltiazem

Which CCBs do you use if the patient has an AV Block?

Nifedipine or another DHP

Which CCBs do you use with variant (Prinzmetal) angina?

DHPs

Which DHP is most potent and thus has the most side effects?

Nifedipine

Which CCBs cause constipation?

Verapamil and Diltiazem

Which CCB makes angina worse in 10% of patients?

Nifedipine

Which CCB is the preferred one to be combined with a beta blocker?

Amlodipine

How would you manage a patient over 65 yrs old c/o chest pain for over 20 minutes? You note on ECG that there were ST and T wave changes and that there is pulmonary edema. Patient has never had this before.

Considered unstable angina until proven that it gets better with rest and worse with exertion. Give nitrates first and morphine for pain. Then add the beta blocker and ASA or Heparins for anticoag. Use Verapamil or Diltiazem if can't tolerate beta blocker. Add a CCB if sx continue even when on nitrate and beta blocker.