This document discusses anti-anginal drugs used to treat angina pectoris. It describes the etiology and physiology of angina pectoris and summarizes the mechanisms of action, side effects, and drug interactions of various therapeutic agents including organic nitrates, calcium channel blockers, and beta blockers. It then presents a case study of a 52-year-old man who experiences chest pain after exercise and is relieved by nitroglycerin, and points to consider regarding his lifestyle, potential type of angina, drug interactions, and patient education.

1. Anti-Anginals

2. Angina Pectoris Etiology Classic stable Effort induced Variant (Prinzmetal’s) Coronary artery spasm Unstable Increase frequency Decrease response to treatment

3. Physiology Oxygen demand rises Oxygen supply declines

4. Therapeutic Agents Organic Nitrates MOA Preload Afterload Side Effects Tolerance & dependence Nitroglycerin Routes of administration Drug interactions

5. Calcium Channel & Beta Blockers MOA SE Drug Interactions Patient education MOA SE Drug Interactions Hypoglycemic agents Patient education

6. Angina Case Study

7. PC , 52, diagnosed with HTN x5yrs. He has lost 33#, watched his diet and walks around Spring Lake 3 x a week. He still has 30 # to goal. His PCP was encouraged by the lifestyle changes that she lowered the Metformin from 850mg BID 3 weeks ago. He arrives in the ER straight after his walk because of indigestion, burning in his neck and jaw that will not go away. He was given 0.4mg NTG sl stat & pain was relieved in the first dose. Med HX: HTN x 5 yr AODM x8 yr Personal HX: father died at 40yr mother obese 72yr old, but suffered stroke and is in a SNF x 2 yr. Medications: Metformin 500mg BID HCTZ 25mg QD Verapamil SA 240mg QD Viagra 50mg 1 hr before VS: T 37 P 95 BP 134/86 Glucose 125 (65-110) Social HX: occas ETOH, non-smoker x 10yr, coffee 6-8 cups/d, Alka Seltzer prn, Primatine Mist for tight chest

8. Points to Ponder Discuss lifestyle. What elements contribute positively or negatively? Type of angina. What potential drug interactions are present? What patient education would you give him? Comments of drug therapy.