Anti-AnginalsAnti-Anginals

Angina PectorisAngina Pectoris EtiologyEtiology

Classic stableClassic stable Effort inducedEffort induced

Variant (Prinzmetal’s)Variant (Prinzmetal’s) Coronary artery spasmCoronary artery spasm

UnstableUnstable Increase frequencyIncrease frequency Decrease responseDecrease response to treatmentto treatment

PhysiologyPhysiology Oxygen demandOxygen demand

risesrises

Oxygen supplyOxygen supply declinesdeclines

Therapeutic AgentsTherapeutic Agents Organic NitratesOrganic Nitrates

MOAMOA PreloadPreload AfterloadAfterload

Side EffectsSide Effects Tolerance & Tolerance &

dependencedependence NitroglycerinNitroglycerin

Routes of Routes of administrationadministration

Drug interactionsDrug interactions

Calcium Channel & Beta Blockers Calcium Channel & Beta Blockers

MOAMOA SESE Drug InteractionsDrug Interactions Patient educationPatient education

MOAMOA SESE Drug InteractionsDrug Interactions

Hypoglycemic Hypoglycemic agentsagents

Patient educationPatient education

Angina Case StudyAngina Case Study

PC , 52, diagnosed with HTN x5yrs. He has lost 33#, PC , 52, diagnosed with HTN x5yrs. He has lost 33#, watched his diet and walks around Spring Lake 3 x watched his diet and walks around Spring Lake 3 x a week. He still has 30 # to goal. His PCP was a week. He still has 30 # to goal. His PCP was encouraged by the lifestyle changes that she encouraged by the lifestyle changes that she lowered the Metformin from 850mg BID 3 weeks lowered the Metformin from 850mg BID 3 weeks ago. He arrives in the ER straight after his walk ago. He arrives in the ER straight after his walk because of indigestion, burning in his neck and jaw because of indigestion, burning in his neck and jaw that will not go away. He was given 0.4mg NTG sl that will not go away. He was given 0.4mg NTG sl stat & pain was relieved in the first dose.stat & pain was relieved in the first dose.

Med HX: HTN x 5 yr AODM x8 yr Personal HX: Med HX: HTN x 5 yr AODM x8 yr Personal HX: father died at 40yr mother obese 72yr old, but father died at 40yr mother obese 72yr old, but suffered stroke and is in a SNF x 2 yr.suffered stroke and is in a SNF x 2 yr.

Medications: Metformin 500mg BID HCTZ 25mg QD Medications: Metformin 500mg BID HCTZ 25mg QD Verapamil SA 240mg QD Viagra 50mg 1 hr before Verapamil SA 240mg QD Viagra 50mg 1 hr before

VS: T 37 P 95 BP 134/86 Glucose 125 (65-110)VS: T 37 P 95 BP 134/86 Glucose 125 (65-110)Social HX: occas ETOH, non-smoker x 10yr, coffee 6-8 Social HX: occas ETOH, non-smoker x 10yr, coffee 6-8

cups/d, Alka Seltzer prn, Primatine Mist for tight cups/d, Alka Seltzer prn, Primatine Mist for tight chestchest

Points to PonderPoints to Ponder

• Discuss lifestyle. What elements Discuss lifestyle. What elements contribute positively or negatively?contribute positively or negatively?

• Type of angina.Type of angina.• What potential drug interactions are What potential drug interactions are

present?present?• What patient education would you What patient education would you

give him?give him?• Comments of drug therapy.Comments of drug therapy.