Flashcards in Chronic Stable Angina Deck (22):
What are the 3 main goals of angina therapy?
1. prevent progression to unstable angina, MI or death
2. provide relief of anginal sxs
3. modify risk factors for CAD
What therapies are used to prevent progression of chronic stable angina?
What medications are used to provide relief of anginal sxs in chronic stable angina?
How can a pt modify his or her risk factors for CAD?
-exercise and weight control
What drug (and dose) should all patients (unless CI) be taking for their chronic stable angina?
-aspirin 75-162 mg per day
What is the goal of anginal pain treatment with BB? (think vital signs)
-target resting HR of 55-60 bpm
What are the cautions for BB use for relief of angina?
-type I DM (BB increase glucose levels)
-asthma (BB cause constriction in lungs)
-mod-severe peripheral vascular dz
What are the CIs for BB use for relief of angina?
-bradycardia (HR <50)
-2nd degree heart block
Which pts might be good candidates for trying a BB first for anginal relief?
-pts with hard indications and NO CI: 6 months post MI or systolic HF (EF <40%)
What should you not do if your pt is on a BB or you are considering a BB?
-do not start BB with HR<55
-do not increase dose with HR at goal
When should CCB dihydropyridines be used for angina relief?
-add to BB if HR < goal
-combine with long-acting nitrates in pts who can't take BB or non-DHP
When should CCB non-dihydropyridines be used for angina relief?
-HR> goal and a BB would be CI or no hard indication w/ cautions
CCB Adverse Effects
-left ventricular dysfunction
-bradycardia (<50 bpm)
-2nd or 3rd degree AV block
When should you NOT start a DHP?
-don't start with >2+ pitting edema
-don't start with orthostatic HoTN
MOA of Nitrates
-dilates peripheral veins at large doses
-dilates coronary arteries at all doses
-nitrates will not affect BP!
When might long acting nitrates be used?
-long term prophylaxis
-generally added on to other therapies (eg BB or non-DHP to improve sxs control)
-combine with DHP if pt can't tolerate BB or non-DHP
When might short acting nitrates be used?
-terminate acute anginal attack
-prevention of effort or stress-induced attacks
How should an angina patient respond to chest pain?
-stop activity, sit down, take one NTG
-if pain not improved or worse in 5 mins, take NTG and call 911
-can repeat q5 minutes for total of 3 doses
What is LA Nitrate Tolerance?
-decreases response or increased amount needed for same effect
What is a daily nitrate free interval? When should patients dose? What is the purpose?
-8-12 hour period of no nitrate meds
-dose at 8 am and 2 pm
-decreases nitrate tolerance