Chest Pain, Coronary Vasodilators, Statins and Nitro

Coronary Vasodilators are used in the treatment of angina, which could be due to insufficient blood supply or ischemia. Vasodilators dilate these blood vessels and stop attacks of angina. They can also reduce the frequency of angina pectoris when administered prophylactically using beta-blockers, calcium channel blockers and nitrates. Nitrates such as isorbide and nitroglycerin are most commonly used for relief of acute angina pectoris as well as long term prophylactic management. Nitroglycerin comes in several forms.

It can be administered at five minute intervals with no more than three doses given in a 15 minute period. After that, contact physician. Nitroglycerin tablets and capsules must be stored only in glass containers with tightly fitting screw tops away from heat. This is because plastic containers can absorb meds. For long term prophylactic management of angina, topical transdermal patches are use. Nitro Bid is applied every 8 hour whereas Nitro-dur or transderma-Nitro applied every 24 hour. Apply the patches to dry, hairless upper part of the body. Don’t apply below elbow or knee. Sites should be rotated and abrupt withdrawal should be avoided. Side effects of hypersensitivity reactions enhanced by alcohol include tachycardia, night sweats and syncope.

Vasodilators are contraindicated in I C P, severe anemia and glaucoma. Phosphodieterase (P D E)  inhibitors such as Viagra is contraindicated in nitrates because they can cause large, sudden, dangerous drop in blood pressure. Administer fast-acting nitrate sublingual tablets or spray while sitting down because of risk for sudden lightheadedness.

4. Antilipemic Agents lower blood cholesterol; they include statins, bile acid sequestrants, niacin, fibric acid derivatives and cholesterol absorption inhibitor.. High cholesterol levels could lead to dementia, stroke, hardening of arteries, blood clots, etc. Lipoproteins are responsible for transporting cholesterol and other fats through blood stream. First L D L transports cholesterol in the blood and deposit in the arterial walls. Very low density lipoproteins, triglycerides are precursors of L D L and compose the largest proportion of lipids in the diet, adipose tissue, and the blood. H D L transports cholesterol from walls of the arteries to the liver for excretion. Take antilipemic with meals to reduce GI upset.

– Statins or H M G – C O A reductase inhibitors inhibit the enzyme for cholesterol synthesis. Statins are the most potent lipid-lowering medications available for monotherapy. They also increase H D L and reduce triglycerides. Side effects include elevated liver enzymes, muscle weakness and rarely rhabdomyolysis. Take statins at night because body synthesizes most cholesterol at night. Avoid grapefruit juice with statins.

– Bile Acid Sequestrants are the resins cholestyramine and colestipol which are not absorped from the GI tract. But they bind bile acids in the intestine, interrupting the process by which bile acids are returned to the liver for reuse. Side effects include heartburn and bloating.

– Nicotinic Acid or Niacin reduces hepatic synthesis of triglycerides and limits secretion of V L D L by inhibiting the mobilization of free fatty acids from the peripheral tissues. It raises H D L cholesterol levels. For diabetic dyslipidemia use niacin with statins. Side effects include skin flushing, glucose intolerance and hyperurecemia.

– Fibric Acid Derivatives or Firbates posses minimal L D L reducing capacity but are effective in treating high triglyceride levels and hyperlipidemia.

– Cholesterol Absorption Inhibitor such as ezetimibe inhibits intestinal absorption of both dietary and biliary cholesterol, blocking its transport in the small intestine. Ezetimibe is well tolerated with back pain and arthralgia being reported.


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