Classic angina

Angina of effort or exercise d/t coronary atherosclerotic occlusion

Want to decrease O2 requirement by decreasing TPR, CO or both (nitrates, CCBs, beta blockers)

Vasospastic/variant angina

aka Prinzmetal d/t reversible decrease in coronary blood flow

Want to increase O2 delivery by decreasing spasm (nitrates & CCB's, NOT beta blockers!)

Unstable angina

Nitrates

MOA: utilize cysteine w/in the body to convert eventually to NO which activates guanylyl cyclase and inturn makes cGMP --> relaxation of the vessel

(essentially a prodrug of NO)

Venodilation --> dec. preload --> dec. cardiac work --> O2 requirement

Decrease infarct size and post MI mortality

Nitroglycerin (SL,transdermal,IV) & Isosorbide

Uses: 1st used immediately, 2nd used for chronic

SE: flushing, HA, orthostatic hypotension

reflex tachycardia, fluid retention

 Cautions: tachyphylaxis (rapid tolerance)

cardiovascular toxicity w/ sildenafil

CCB's

All can be used but mostly -dipines

Nifedipine important for vasospastic angina and DOC for Raynaud's

Beta blockers

Number 1 preventative in classic angina (carvedilol is equivalent to isosorbide in angina of effort) 

Contraindicated in vasospastic angina

Steps to follow post MI

1st = MONA (morphine, O2, nitrates, ASA)

2nd = beta blockers, AECI, statins