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sudden pain beneath the sternum, often radiating to left arm and shoulder; oxygen supply to the heart is insufficient to meet demand 3 main objextives of therapy: minimized frequency, intensity and duration of attacks; improve pts functional capacity with as few AEs as possible; prevent or delay the worst possible outcome: MI Stable Angina: AKA: classic, effort, exertional patho: large meals, emotional excitement, cold exposure, CAD, nicotine, alcohol, caffeine intense pain that subsides w/in 15 min w/rest or rx therapy
vOrganic Nitrates
dilate all blood vessels including coronary arteries
long acting - prophylaxis, short acting - acute attacks
Beta Blockers
decrease O2 demand by slowing conduction, reducing contractility and slowing the HR; opposes reninl
propranolol metoprolol atenolol nadol AEs: brady, HypoTN, decreased AV conduction, reduction of contractility, asthmatic effects (wheezing, dyspnea), insomnia, depression, lethargy, drowsiness, bizarre dreams, sexual dysfunction/impotence use w/caution in pts with diabetes
ranolazine Calcium Channel Blockers block Ca channels in VSM verapamil new class of anti-anginals not 1st line therapy - combine with 1st line agents if inadequate response to other 1st line meds does not reduce HR, BP, or vascular resistance known to prolong QT interval Contraindications: pts w/pre-existing QT prolongation, hepatic impairment, taking other QT prolonging drugs, taking other moderately potent CYP450 inhibitors interactions: QT drugs, CYP450 drugs, dig (increase dig levels), ketoconazole & verapamil (raise ranolazine levels)
diltiazem
nifedipine AEs: dry cough, dilation of periheral arterioles, reflex tachy, HypoTN, brady, HF, AV block, GI: constipaiton, nausea, etc; dermatitis, dyspnea, rash, flushing, peripheral edema, wheezing
Risk Factors: Rx prevention of MI and death: smoking high cholesterol hypertension Revascularization Therapy coronary artery bypass graft (CABG) percutaneous transluminal coronary anginoplasty (PTCA)
antiplatelet drugs
cholesterol lowering drugs ACE inhibitors anti-anginal agents
diabetes
obesity physical inativity