Angina

TherapeuticsAn introduction

Types of Angina
1) Stable angina 2) Unstable angina

Fixed Obstruction Transient obstruction Precipitation by increased Occurs on lower levels oxygen requirement. of exercise Predictable on exercise. Unpredictable

Types of Angina
3) Prinzmetal angina Spasm Unpredictable.

Treatment Aim: Restore oxygen balance

Four classes of drugs

Nitrates All classes of angina

Beta-blockers Stable and unstable

Calcium Antagonists All types

Potassium Channel Activators All types

Beta-blockers
Action
Decreases heart work Blocks sympathetic input.

Cardioselective Eg bisoprolol 5-10mg Daily Carvedilol 12.5mg od

Non-cardioselective Oxprenolol (trasicor) 40mg bd-tds

Side Effects of Beta Blockers

See case history. Make a list of the most important side effects and write them below:

Nitrates- action

Nitrates Venodilation Venous pooling Decreased venous return heart Decreased preload Decreased oxygen needs

Nitrates- action 2

Nitrates

Arteriolar dilation

Decrease in afterload Redistributes blood to ischaemic Regions of myocardium

Nitrates- preparations
Preparations Long acting

GTN sustained Release Eg:suscard buccal Tabs 2mg prn tds

Isosorbide Mononitrate Eg Ismo 20mg bdtds

Isosorbide Dinitrate Cedocard retard 20mg bd

Nitrates preparations cont.

Short acting

Sprays GTN Lingual, buccal, Sublingual Eg nitrolingual 400mcg

Tablets GTN lingual, buccal, Sublingual ( 300-600mcg) Eg: GTN tabs

Sprays and tabs ISDN tabs: 10mg Sprays: angitak

Side Effects and Contraindications of Nitrates

Research these and write them here:

Calcium Channel Blockers primary action:

Decrease oxygen consumption

Blocks Ca into cells

Decreases breakdown of ATP

Increased efficiency of contraction

Decreased oxygen consumption

Calcium Channel Blockers

1. Look up two different classes of calcium channel blockers and for each design a pyramid diagram as in slides 8 and 9. What side effects are commonly encountered? Why is this so? What precautions are needed when prescribing these drugs?