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Pre Reg Pharmacy > Chapter 2 - Stable Angina > Flashcards

Chapter 2 - Stable Angina Flashcards

1
Q

What are the symptoms of stable angina?

A

Predictable chest pain
This may radiate to the neck, shoulders, jaw or arms

Precipitated by exercise or stress

Relieved by rest/GTN

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2
Q

What happens during a stable angina?

A

There is atherosclerotic plaques in the coronary arteries that restrict the flow of blood and oxygen to the heart

There is also an increase in oxygen demand within the heart due to exercise/stress

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3
Q

What are some complications of angina?

A

Unstable angina
MI
Stoke

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4
Q

What is Prinzmetal’s angina?

A

This is caused by narrowing of the proximal coronary artery due to spasm, causing pain at rest

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5
Q

How should acute angina attacks be managed?

A

With sublingual GTN (tablets or spray)

When chest pain is experienced:
Stop activity and rest
Take sublingual GTN
If pain persists after 5 mins, take another
If pain persists 5 mins after the second dose, call 999

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6
Q

When should long term anti-anginal therapy be considered?

A

When patients are experiencing more than 2 acute anginal attacks a week

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7
Q

What is first-line for long-term prevention of angina?

A

Beta blockers e.g. atenolol, bisoprolol

Or rate limiting CCB e.g. diltiazem, verapamil

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8
Q

What should be done if beta-blockers or CCBs alone fail to control anginal symptoms?

A

Use a beta-blocker and a dihydropyradine CCB e.g. amlodipine

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9
Q

What should be done if beta-blockers and/or CCBs don’t effectively control anginal symptoms?

A 
Add either a:
Long acting nitrate
Nicorandil
Ivabradine
Ranolazine
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10
Q

When should a patients response to anginal treatments be monitored?

A

2-4 weeks after a change in drug therapy

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11
Q

Should patients with angina be considered for secondary prevention of CV events?

A

Yes - aspirin 75mg daily and a statin

And an ACEi should be considered especially if the patient has diabetes

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12
Q

What is the mechanism of action of nitrates?

A

Reduction in venous return (which reduced left ventricular work)

Coronary vasodilator

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13
Q

How long does the effect of GTN sublingual tablets/spray last?

A

20-30 mins

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14
Q

How long does the action of isosorbide dinitrate last?

A

Standard release - a few hours

Modified release - 12 hours

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15
Q

What are the contraindications of nitrates?

A

Hypotension
Hypovolaemia
Marked anaemia

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16
Q

Which formulation of nitrates carries the highest risk of tolerance and how is this risk reduced?

A

Transdermal patches

Leave off for 8-12 hours a day (usually this is overnight)

17
Q

When should isosorbide mononutrate be taken?

A

Standard release, usually BD, take second dose 8 hours after the first to reduce the risk of tolerance

Modified release - usually OD

18
Q

What are the side effects of nitrates?

A

Flushing
Headache
Postural hypotension
Arrhythmia

19
Q

When should GTN tablets be discarded after opening?

A

8 weeks

20
Q

Which GTN preparations are P meds?

A

Tablets
Spray
Patch

21
Q

What is the MRHA advice regarding nicorandil?

A

Nicorandil can cause serious skin, mucosal, eye and GI ulceration

22
Q

When can ivabradine be given in angina?

A

Patients who are in sinus rhythm

Patient who have a heart rate >70bpm (discontinue below 59bpm)

23
Q

What does ivabradine interact with?

A

CYP3A4 inhibitors

Other drugs that also prolong the QT interval e.g. amiodarone

24
Q

What are some side effects of ranolazine?

A

Weight loss
QT interval prolongation
AKI
Dehydration

25
Q

What is the brand name of ranolazine?

A

Ranexa

26
Q

What group of anti anginal drugs commonly causes peripheral oedema?

A

CCBs

27
Q

Can beta blockers be used with verapamil or diltazem?

A

No

Risk of bradycardia and hypotension

28
Q

When should ivabradine be discontinued in stable angina?

A

Heart rate falls below 50bpm

No effect after 3 months

29
Q

What is the most cardioselective CCB?

A

Verapamil

30
Q

Which cardio drug can cause gingival hyperplasia?

A

CCBs

31
Q

Which CCB commonly causes constipation?

A

Verapamil

32
Q

Should patients sit or stand when taking nitrates?

A

Sit - can cause dizziness

Pre Reg Pharmacy (36 decks)

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