Pharmacological Therapy of Angina

- acute

- continuing

Acute - Nitrates GTN or isosorbide dinitrate sublingully

Continuing

- aspirin OR clopidegrol

- atenolol OR metoprolol (BBs)

- GTN spray prior to exertion

*IF BBs not work alone ADD CCBs nifedipine OR amlodipine, AND/OR nitrates isosorbide mononitrate OR GTN transdermal.

*IF BB contraindicated use Verapamil OR Diltiazem

Unstable Angina / NSTEMI

INITIAL

Anti-platelet - aspirin OR clopidogrel

Beta-blockers - atenolol OR metoprolol

Antithrombin - dalteparin OR enoxaparin for 3 days, OR unfractionated heparin

CONTINUING - same as hypertension (GTN, BBs, CCBs)

Unstable Angina / NSTEMI

What pharm therapy is used for percutaneous

Platelet II_b/III_a receptor antagonists

tirofiban and abxicmab

IV before percutaneous coronary intervention (PCI)

STEMI

PCI therapy of choice.

adjuvant therapy includes....

opioid

rapid thrombolysis - streptokinase, retelplase

aspirin,

beta blocker

ACE inhibitor

statin

**herparin used prior to PCI

STEMI

Contraindications for thrombolytic therapy?

• Active internal bleeding
• Surgery within a month
• Stroke in the past 6 months
• Severe hypertension
• Prolonged cardiopulmonary resuscitation

Subsequent management of STEMI

Aspirin

BBs or ACEIs

Statins

CCBs (verapamil) when BBs C/I