Angina drug therapy

Exercise facilitates both weight loss and blood pressure reduction. In addition, regular exercise improves functional capacity and symptoms in chronic stable angina.1 Once drug therapy for IHD is instituted, patients should be encouraged... 

Is the patient taking any medications/supplements that may exacerbate angina or interact with anti-anginal drug therapy ... 

Concomitant drug therapy - Concomitant drug therapy with -blockers may be beneficial in chronic stable angina however, the effects of concurrent... 

Drug therapy of acute coronary syndromes including unstable angina and non-Q-wave myocardial infarction includes use of aspirin, heparin and anti-ischaemic drugs and is similar in older patients to other age groups. Activation of platelet thromboxane production in the coronary circulation has been demonstrated in unstable angina. The risk of myocardial infarction or death is reduced by approximately 50% by early aspirin therapy in recommended doses of 160-325 mg per day and continued... 

Parker JD and Parker JO. Drug therapy Nitrate therapy for stable angina pectoris. N Engl J Med... 

Mechanisms in angina pectoris in relation to drug therapy, 10, 93... 

The principal forms relevant to choice of drug therapy are angina of exercise (commonest) and its worsening form, unstable (preinfarction or crescendo) angina (see below), which occurs at rest. Variant (Prinzmetal) angina (very uncommon) results from spasm of a large coronary artery. 

Mass spectrometry in drug research. 6. 157 Mechanisms in angina pectoris in relation to drug therapy. 10. 93 Mechanisms of action of antiinflammatory drugs. 14. 147 Mechanisms of insulin action. 27. 25... 

Dwivedi SK, Saran RK, Mittal S, et al. Silent ischemic interval on exercise test is a predictor to drug therapy A randomized crossover trial of metoprolol versus diltiazem in stable angina. CUn Cardiol 2001 24 45-49. 

Patients who tolerate hypotension poorly should avoid second-generation ai-adrenergic antagonists. This includes patients with poorly controlled angina, serious cardiac arrhythmias, patients with reduced circulating volume, and patients on multiple antihypertensives. These patients are candidates for tamsulosin or finasteride, if drug therapy is deemed necessary. Whether extended-release alfuzosin is also a good choice remains to be elucidated in controlled comparison trials with tamsulosin. 

Mr Butler is a 55-year-old patient with a history of heart disease. He had a heart attack 10 years ago and was successfully treated with by-pass surgery. Up until quite recently, the patient was relatively well. The present diagnosis is angina (mild on exertion) and high blood pressure controlled by drug therapy. Mr Butler developed type 2 diabetes two years ago. 

Recommended Drug Therapy for Angina in Patients with Other Medical Conditions... 

C03-0117. Heart disease causes 37% of the deaths in the United States. However, the death rate from heart disease has dropped significantly in recent years, partly because of the development of new drugs for heart therapy by chemists working in the pharmaceutical industry. One of these drugs is verapamil, used for the treatment of arrhythmia, angina, and h q)ertension. A tablet contains 120.0 mg of verapamil. Determine the following quantities (a) the molar mass of verapamil (b) the number of moles of verapamil in one tablet and (c) the number of nitrogen atoms in one tablet. 

All patients taking these drugs for long-term hypertension therapy should first receive both a diuretic and a /1-blocker. The diuretic minimizes the side effect of sodium and water retention. Direct vasodilators can precipitate angina in patients with underlying coronary artery disease unless the baroreceptor reflex mechanism is completely blocked with a /3-blocker. Nondihydropyridine CCBs can be used as an alternative to /3-blockers in patients with contraindications to /3-blockers. 

Blockers (without ISA) are first-line therapy in chronic stable angina and have the ability to reduce BP, improve myocardial consumption, and decrease demand. Long-acting CCBs are either alternatives (the nondihy-dropyridines verapamil and diltiazem) or add-on therapy (dihydropy-ridines) to /1-blockers in chronic stable angina. Once ischemic symptoms are controlled with /1-blocker and/or CCB therapy, other antihypertensive drugs (e.g., ACE inhibitor, ARB) can be added to provide additional CV risk reduction. Thiazide diuretics may be added thereafter to provide additional BP lowering and further reduce CV risk. 

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