Chapter 2 - Stable Angina Flashcards Preview

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Flashcards in Chapter 2 - Stable Angina Deck (32)
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1

What are the symptoms of stable angina?

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

Precipitated by exercise or stress

Relieved by rest/GTN

2

What happens during a stable angina?

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

3

What are some complications of angina?

Unstable angina
MI
Stoke

4

What is Prinzmetal’s angina?

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

5

How should acute angina attacks be managed?

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

6

When should long term anti-anginal therapy be considered?

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

7

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

Beta blockers e.g. atenolol, bisoprolol

Or rate limiting CCB e.g. diltiazem, verapamil

8

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

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

9

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

Add either a:
Long acting nitrate
Nicorandil
Ivabradine
Ranolazine

10

When should a patients response to anginal treatments be monitored?

2-4 weeks after a change in drug therapy

11

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

Yes - aspirin 75mg daily and a statin
And an ACEi should be considered especially if the patient has diabetes

12

What is the mechanism of action of nitrates?

Reduction in venous return (which reduced left ventricular work)

Coronary vasodilator

13

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

20-30 mins

14

How long does the action of isosorbide dinitrate last?

Standard release - a few hours
Modified release - 12 hours

15

What are the contraindications of nitrates?

Hypotension
Hypovolaemia
Marked anaemia

16

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

Transdermal patches

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

17

When should isosorbide mononutrate be taken?

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

Modified release - usually OD

18

What are the side effects of nitrates?

Flushing
Headache
Postural hypotension
Arrhythmia

19

When should GTN tablets be discarded after opening?

8 weeks

20

Which GTN preparations are P meds?

Tablets
Spray
Patch

21

What is the MRHA advice regarding nicorandil?

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

22

When can ivabradine be given in angina?

Patients who are in sinus rhythm

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

23

What does ivabradine interact with?

CYP3A4 inhibitors
Other drugs that also prolong the QT interval e.g. amiodarone

24

What are some side effects of ranolazine?

Weight loss
QT interval prolongation
AKI
Dehydration

25

What is the brand name of ranolazine?

Ranexa

26

What group of anti anginal drugs commonly causes peripheral oedema?

CCBs

27

Can beta blockers be used with verapamil or diltazem?

No
Risk of bradycardia and hypotension

28

When should ivabradine be discontinued in stable angina?

Heart rate falls below 50bpm
No effect after 3 months

29

What is the most cardioselective CCB?

Verapamil

30

Which cardio drug can cause gingival hyperplasia?

CCBs