Learning objectives
Upon completion of this chapter, you should be able to:
1.
Describe coronary artery disease, including identified risk factors and clinical presentation.
2.
Describe the therapeutic actions, indications, pharmacokinetics, contraindications and cautions, most
common adverse reactions and important drug–drug interactions associated with the nitrates, beta-blockers
and calcium channel blockers used to treat angina.
3.
Discuss the use of antianginal agents across the lifespan.
4.
Compare and contrast the prototype drugs glyceryl trinitrate, metoprolol and diltiazem with other agents
used to treat angina.
5.
Outline the care considerations, including important teaching points, for people receiving drugs used to
treat angina.
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Antianginal agents
Glossary of key terms
angina pectoris:
“suffocation of the chest”; pain caused by the imbalance between oxygen being supplied to the heart muscle and
demand for oxygen by the heart muscle
atheroma:
plaque in the endothelial lining of arteries; contains fats, blood cells, lipids, inflammatory agents and platelets; leads to
narrowing of the lumen of the artery, stiffening of the artery and loss of distensibility and responsiveness
atherosclerosis:
narrowing of the arteries caused by build-up of atheromas, swelling and accumulation of platelets; leads to a loss
of elasticity and responsiveness to normal stimuli
coronary artery disease (CAD):
characterised by progressive narrowing of coronary arteries, leading to a decreased delivery of
oxygen to cardiac muscle cells; leading killer of adults in the Western world
myocardial infarction:
end result of vessel blockage in the heart; leads to ischaemia and then necrosis of the area cut off from the
blood supply; it can heal, with the dead cells replaced by scar tissue
nitrates:
drugs used to cause direct relaxation of smooth muscle, leading to vasodilation and decreased venous return to the heart
with decreased resistance to blood flow; this rapidly decreases oxygen demand in the heart and can restore the balance between
blood delivered and blood needed in the heart muscle of people with angina
pulse pressure:
the systolic blood pressure minus the diastolic blood pressure; reflects the filling pressure of the coronary arteries
stable angina:
predictable pain due to the imbalance of myocardial oxygen supply and demand that is relieved by rest or stoppage
of activity
unstable angina:
unpredictable episode of myocardial ischaemia with pain due to the imbalance of myocardial oxygen supply and
demand when the person is at rest
variant (Prinzmetal or vasospastic) angina:
drop in blood flow through the coronary arteries caused by a vasospasm in the artery,
not by atherosclerosis
Test your current knowledge of antianginal agents with a PrepU Practice Quiz!
Simulation-based learning
On completion of the chapter, consider the scenario of Carl Shapiro (Part 2) who arrives in the emergency department.
Consider the medication management of Carl’s condition, as it relates to your learning in this chapter.
