Angina Pectoris

• Angina pectoris - a medical term for chest pain or discomfort due to coronary heart disease.
• Angina pectoris - occurs when the heart muscle does not get much blood as it needs.
• Symptoms of Angina Pectoris

  1. Uncomfortable pressure
  2. Feeling of fullness
  3. Squeezing or pain in the center of the chest
  4. Discomfort in the neck, jaw, shoulder, back or arm
• Nitrates (vasodilators) - relax and widen the blood vessels so more blood flows to the heart.
• NITRATES

  Nitroglycerin
• Preparation of Nitrates

  1. injection
  2. buccal
  3. sublingual pill
  4. translingual spray
  5. sustained-release tablets
  6. capsules
  7. transdermal patch
  8. ointment
• NITRATES SIDE EFFECTS

  1. Headaches
  2. Dizziness
  3. Nausea
  4. Lightheadedness
  5. Restlessness
  6. Stomach discomfort
  7. Skin rash
  8. Dry mouth
  9. Blurring of vision
  10. Hypotension
  11. arrhythmia
• NITRATES

  Sustained-release tablet or capsule should be given on an empty stomach. Swallow the tablet or capsule whole.
• NITRATES

  For translingual spray: do not shake canister. Spray preferably on or under tongue. Do not inhale spray. Instruct patient to wait at least 10 seconds before swallowing.
• NITRATES

  Put transdermal ointment onto a non-hairy skin surface. Avoid getting ointment on fingers. Rotate application sites to prevent dermal inflammation and sensitization.
• Aspirin - reduces blood clotting, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can reduce the risk of heart attack.
• ASPIRIN SIDE EFFECTS

  1. Hypersensitivity (bronchospasm, anaphylactic shock)
  2. Dizziness
  3. Confusion
  4. drowsiness
  5. tinnitus, hearing loss
  6. Vomiting, nausea, diarrhea, anorexia, heartburn, stomach pains, ulcerations, occult bleeding
  7. Thrombocytopenia
  8. Hemolytic anemia
  9. Petechiae, easy bruising, rash
  10. Impaired renal function
• ASPIRIN

  Give with a full glass of water (240 ml), milk, food or antacid to minimize gastric irritation.
• Clot-preventing drugs - make blood platelets less likely to stick together, so blood does not clot. This is recommended if the patient can’t take aspirin.
• CLOT-PREVENTING DRUGS

  1. Clopidogrel
  2. Prasugrel
  3. Ticagrelor
• SIDE EFFECTS OF ANGINA PECTORIS

  1. Flu-like syndrome
  2. Fatigue
  3. Pain
  4. Arthralgia
  5. Back pain
  6. Chest pain
  7. Edema
  8. HPN
  9. Thrombolytic purpura
  10. Abdominal pain
  11. Dyspepsia
  12. Diarrhea
  13. Nausea
  14. Hypercholesterolemia
  15. Epistaxis
  16. Headache
  17. Dizziness
  18. Depression
  19. Upper respiratory infection
  20. Dyspnea
  21. Rhinitis
  22. Bronchitis
  23. Cough
  24. Rash
  25. Pruritus
• CLOT-PREVENTING DRUGS

  Do not use in breastfeeding mothers or those who are scheduled for surgery at least 7 days before surgery.
• CLOT-PREVENTING DRUGS

  NSAIDS - increase risk of bleeding
• CLOT PREVENTING DRUGS

  Feverfew, garlic, ginger, gingko - herbals that increase risk of bleeding
• RANOLAZINE (Ranexa) – this may be prescribed for chronic stable angina that does not get better with other medications. It may be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.
• Side effects of Ranolazine

  1. Lightheadedness
  2. Fast or pounding heartbeats
  3. Fluttering in the chest
  4. Little or no urination
  5. Painful or difficult urination
  6. Swelling in the feet or ankles
  7. Shortness of breath
  8. Nausea
  9. Constipation
  10. Headache
  11. Dizziness
  12. Bradycardia
  13. Vertigo
  14. Hematuria
  15. Dyspnea
  16. Hyperhidrosis
  17. hypotension
• Should not be taken with ranolazine

  1. Rifampicin
  2. Phenobarbital
  3. Phenytoin
  4. Carbamazepine
  5. St. John's Wort